Provider Demographics
NPI:1497353874
Name:BIRD, BRIANNE JEAN
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:JEAN
Last Name:BIRD
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 1:291 E SWANSON AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7004
Mailing Address - Country:US
Mailing Address - Phone:907-376-3275
Mailing Address - Fax:
Practice Address - Street 1:291 E SWANSON AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7004
Practice Address - Country:US
Practice Address - Phone:907-376-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist