Provider Demographics
NPI:1417451832
Name:BRELAND, JASMYN MARIE (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:JASMYN
Middle Name:MARIE
Last Name:BRELAND
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7641 SUMTER CREST DR APT 7302
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6744
Mailing Address - Country:US
Mailing Address - Phone:910-316-0980
Mailing Address - Fax:
Practice Address - Street 1:7641 SUMTER CREST DR APT 7302
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6744
Practice Address - Country:US
Practice Address - Phone:910-316-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management