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General NPI Number Information
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NPI Number | 1689568826
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Entity Type | Individual
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Provider Name | BREANA MICHELLE VINCENT
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Gender | Female
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 2700 DOLBEER ST
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City | EUREKA
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State | CA
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Zip | 95501-4736
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Country | US
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Telephone | 707-445-8121
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Fax |
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Provider Business Mailing Address
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Address Line | 377 FRANCESCO PL
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City | FORTUNA
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State | CA
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Zip | 95540-2896
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 66457
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License Number State | CA
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