Individual
BREANNA MAE MERRIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12275 16TH ST APT C, YUCAIPA, CA 92399-1773
(951) 805-6107
Mailing address
12275 16TH ST APT C, YUCAIPA, CA 92399-1773
(951) 805-6107
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
700747
CA
Other
Enumeration date
10/18/2019
Last updated
10/18/2019
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