Individual
MISTY BREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
HWY 160/163 BUILDING KA 2010, KAYENTA, AZ 86033
(928) 697-4100
Mailing address
139 ELK DRIVE, EAGLE BUTTE, SD 57625
(985) 518-9432
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R045218
SD
163WE0003X
Emergency Registered Nurse
R045218
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060012
—
AZ
Enumeration date
03/27/2015
Last updated
03/27/2015
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