Organization
MARTHA A. BRECKENRIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARTHA ANN BRECKENRIDGE WHNP (DIRECTOR)
(214) 724-3723
Entity
Organization
Contact information
Practice address
1505 SANDSTONE CT, DESOTO, TX 75115-7841
(214) 724-3723
Mailing address
PO BOX 346, DESOTO, TX 75123-0346
(469) 567-1234
(972) 224-5403
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
363LW0102X
Women's Health Nurse Practitioner
Primary
242859
TX
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
242859
TX
Other
Enumeration date
05/02/2007
Last updated
10/20/2023
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