Basic Information
| Provider Information | |||||||||
| NPI: | 1548918824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREESE | ||||||||
| FirstName: | CARI | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 FREEMAN RD E | ||||||||
| Address2: | |||||||||
| City: | FIFE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984243776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539424722 | ||||||||
| FaxNumber: | 2539424722 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 FREEMAN RD E | ||||||||
| Address2: | |||||||||
| City: | FIFE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984243776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539424722 | ||||||||
| FaxNumber: | 2539424722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2022 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.