Provider Demographics
NPI:1649717851
Name:RAYMOND, BREANN MARIE
Entity type:Individual
Prefix:
First Name:BREANN
Middle Name:MARIE
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREANN
Other - Middle Name:MARIE
Other - Last Name:SCHAFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:914 S 12TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5941
Mailing Address - Country:US
Mailing Address - Phone:701-255-4242
Mailing Address - Fax:
Practice Address - Street 1:914 S 12TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5941
Practice Address - Country:US
Practice Address - Phone:701-255-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR38914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily