Provider Demographics
NPI:1609697895
Name:CHARLES, BREANNA LYNN (APRN-CPNP)
Entity type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:LYNN
Last Name:CHARLES
Suffix:
Gender:F
Credentials:APRN-CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34664 BRAEMORE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-6432
Mailing Address - Country:US
Mailing Address - Phone:216-978-2574
Mailing Address - Fax:
Practice Address - Street 1:8950 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-444-0322
Practice Address - Fax:216-445-9409
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031784363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics