Provider Demographics
NPI:1851987259
Name:GAINES, BREYONNA NICHELLE (DOULA)
Entity Type:Individual
Prefix:
First Name:BREYONNA
Middle Name:NICHELLE
Last Name:GAINES
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4562 W PALO ALTO AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2920
Mailing Address - Country:US
Mailing Address - Phone:510-780-6282
Mailing Address - Fax:
Practice Address - Street 1:4562 W PALO ALTO AVE APT 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-2920
Practice Address - Country:US
Practice Address - Phone:510-780-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula