Basic Information
| Provider Information | |||||||||
| NPI: | 1639664766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILES | ||||||||
| FirstName: | BREELYN | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 E BUTLER RD | ||||||||
| Address2: | |||||||||
| City: | MAULDIN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296622169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433443035 | ||||||||
| FaxNumber: | 9783277938 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 CHALKSTONE AVE APT 3 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029084728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014562000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2018 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | LPR00194 | RI | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | LPR00194 | RI | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.