Provider Demographics
NPI:1619342573
Name:BRESHEARS, STACEY (MS, RD, CDCES)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:BRESHEARS
Suffix:
Gender:F
Credentials:MS, RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 QUEEN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4130
Mailing Address - Country:US
Mailing Address - Phone:808-620-5553
Mailing Address - Fax:833-672-3405
Practice Address - Street 1:1050 QUEEN ST STE 100
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4130
Practice Address - Country:US
Practice Address - Phone:802-333-0057
Practice Address - Fax:833-672-3405
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered