Provider Demographics
NPI:1316246127
Name:SHULTS, BREANNE NICOLE (CDM)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:NICOLE
Last Name:SHULTS
Suffix:
Gender:F
Credentials:CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 S. NISSEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645
Mailing Address - Country:US
Mailing Address - Phone:907-982-5723
Mailing Address - Fax:
Practice Address - Street 1:2150 S NISSEN DR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9069
Practice Address - Country:US
Practice Address - Phone:907-982-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK69OtherCERTIFIED DIRECT ENTRY MIDWIFE