Provider Demographics
NPI:1356922587
Name:ORETTA, BREONA
Entity type:Individual
Prefix:
First Name:BREONA
Middle Name:
Last Name:ORETTA
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 1:705 14TH ST SE APT 2
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-5640
Mailing Address - Country:US
Mailing Address - Phone:701-269-7018
Mailing Address - Fax:
Practice Address - Street 1:705 14TH ST SE APT 2
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-5640
Practice Address - Country:US
Practice Address - Phone:701-269-7018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant