MEDICARE: MS. BRANICIA D. EVERLASTING DOULA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	174H00000X	Health Educator
2	171400000X	Health & Wellness Coach	IL
3	172V00000X	Community Health Worker
4	374J00000X	Doula	IL
5	374J00000X	Doula	MO

General Provider Information

NPI Number	:	1396406682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRANICIA D. EVERLASTING DOULA

Provider Business Mailing Address
First Line	:	138 N 72ND ST
Second Line	:
City	:	CENTREVILLE
State	:	IL
Zip	:	62203-2604
Country	:	US
Telephone Number	:	618-910-0687
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 IOWA AVE
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62220-3940
Country	:	US
Telephone Number	:	618-910-0687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2022
Last Update Date	:	02/23/2026

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