Individual
BREANNA TAINA WILLEFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
225 BALDWIN AVE, CHARLOTTE, NC 28204-3109
(704) 376-1605
Mailing address
2328 COMMONWEALTH AVE, CHARLOTTE, NC 28205-5130
(704) 376-1605
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
2024-02208
NC
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/10/2019
Last updated
04/28/2026
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