MEDICARE: BREANNA KAYE GAUDETTE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1891598363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA KAYE GAUDETTE

Provider Business Mailing Address
First Line	:	11823 N MADISON ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-2824
Country	:	US
Telephone Number	:	360-619-8797
Fax Number	:

Provider Business Practice Location Address
First Line	:	11823 N MADISON ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-2824
Country	:	US
Telephone Number	:	360-619-8797
Fax Number	:

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

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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Directions to “ BREANNA KAYE GAUDETTE ” Practice Location

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