Provider Demographics
NPI:1831865567
Name:AWEAU, BREANNA BROOKE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:BROOKE
Last Name:AWEAU
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 1:4192 KEANU ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5570
Mailing Address - Country:US
Mailing Address - Phone:808-228-6189
Mailing Address - Fax:
Practice Address - Street 1:4192 KEANU ST APT 2
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5570
Practice Address - Country:US
Practice Address - Phone:808-228-6189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician