BreezyNotes Add User

Contact Type
N/A

Breezy
Breezy ID (or acct ID?)
N/A
User's First and Last Name
N/A

First Name Required Last Name
User's Email Address *
N/A
Practice/Clinic Name
N/A
Select a role for this user *
N/A

Other
Individual NPI (If Applicable)
N/A
State License (If applicable)
N/A
Highest Degree Attained *
N/A

Doctoral Degree
Master's Degree
Bachelor's Degree
Less than Bachelor's Degree
Supervisor's or QSP's Name (if applicable)
N/A

First Name Last Name
Taxonomy Code *
N/A

Choose a taxonomy code. If this user is administrative staff or you do not have their taxonomy code, choose "Unknown or No Taxonomy Code."
Commission Rate (if applicable)
N/A

Please enter as a percentage.
Name of Person Completing this Form (if different from above)
N/A

First Name Last Name
Would you like to add another user? *
N/A

Yes
No