BREAKAWAY FUNCTIONAL MEDICINE NPI 1780528307

NPI Information

  • NPI: 1780528307
  • Provider Name: BREAKAWAY FUNCTIONAL MEDICINE
  • Classification: Nurse Practitioner - 363L00000X
  • Entity Type: Organization
  • Address: 319 S MANDAN ST
    BISMARCK, ND
    ZIP 58504
  • Phone: (480) 262-0249

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NPI Details

BREAKAWAY FUNCTIONAL MEDICINE is a nurse practitioner in Bismarck, ND. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. BREAKAWAY FUNCTIONAL MEDICINE NPI is 1780528307. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

319 S MANDAN ST
BISMARCK, ND
ZIP 58504-558
Phone: (480) 262-0249

The provider's authorized official is Austin Mill .
The authorized official title is Owner and has the following contact phone number (480) 262-0249.

The enumeration date for this NPI number is 4/15/2026 and was last updated on 4/15/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1171400000XHealth and Wellness CoachNo
2363L00000XNurse PractitionerYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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