Provider Demographics
NPI:1003524596
Name:PRINCE, BRIAUNA RACHELLE
Entity Type:Individual
Prefix:
First Name:BRIAUNA
Middle Name:RACHELLE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5652 BONAVENTURE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-7232
Mailing Address - Country:US
Mailing Address - Phone:323-974-0603
Mailing Address - Fax:
Practice Address - Street 1:5652 BONAVENTURE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-7232
Practice Address - Country:US
Practice Address - Phone:323-974-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals