Provider Demographics
NPI:1407503832
Name:FRIES-DANCY, BREANA MICHELLE
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:MICHELLE
Last Name:FRIES-DANCY
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 1:448 GARDEN HWY
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-6348
Mailing Address - Country:US
Mailing Address - Phone:530-702-0053
Mailing Address - Fax:
Practice Address - Street 1:448 GARDEN HWY
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-6348
Practice Address - Country:US
Practice Address - Phone:530-702-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-05
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator