Provider Demographics
NPI:1568971836
Name:ST. GELAIS, BREANNA JEWEL
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:JEWEL
Last Name:ST. GELAIS
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:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:GLENROCK
Mailing Address - State:WY
Mailing Address - Zip Code:82637-0447
Mailing Address - Country:US
Mailing Address - Phone:307-337-7333
Mailing Address - Fax:
Practice Address - Street 1:167 FORT LARAMIE STREET
Practice Address - Street 2:
Practice Address - City:GLENROCK
Practice Address - State:WY
Practice Address - Zip Code:82637
Practice Address - Country:US
Practice Address - Phone:307-337-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula