Provider Demographics
NPI:1003684200
Name:LIBERTAD, BREANNE SYMONDS
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:SYMONDS
Last Name:LIBERTAD
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 1:577 SW 1ST PL
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9635
Mailing Address - Country:US
Mailing Address - Phone:503-440-3342
Mailing Address - Fax:
Practice Address - Street 1:577 SW 1ST PL
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9635
Practice Address - Country:US
Practice Address - Phone:503-440-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula