Petroff, Glenda Carol Breakfell

Petroff, Glenda Carol Breakfell is an sole proprietor health care provider with primary practice located at 22070 Highway 59 , Abita Springs LA 70420. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Petroff, Glenda Carol Breakfell can be contacted via phone (985) 892-0879.

Contact Information

Primary practice address
22070 Highway 59 Abita Springs LA 70420
Fax: (985) 875-2384
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN099641 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN099641AP03834 Louisiana

Profile Details

NPI number 1609879659
LBN Legal business name Petroff, Glenda Carol Breakfell
Credentials FNPC
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 23rd, 2005
Last updated Jan 28th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609879659 NPPES
Louisiana MEDICAID 1128139
Louisiana Other P00239061
Louisiana MEDICAID 07931777

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