Provider Demographics
NPI:1023774205
Name:AILANI-SOLEIL, BREENA ANGELICA (FNP-BC)
Entity type:Individual
Prefix:
First Name:BREENA
Middle Name:ANGELICA
Last Name:AILANI-SOLEIL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 SHIRE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAULSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25876-1700
Mailing Address - Country:US
Mailing Address - Phone:304-877-1023
Mailing Address - Fax:
Practice Address - Street 1:236 WARRIOR WAY
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WV
Practice Address - Zip Code:24867
Practice Address - Country:US
Practice Address - Phone:304-294-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV111003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily