Provider Demographics
NPI:1316626310
Name:TREASTER, BRIANNA NICOLE (CNM)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NICOLE
Last Name:TREASTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SING TREE LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-6368
Mailing Address - Country:US
Mailing Address - Phone:803-603-8753
Mailing Address - Fax:
Practice Address - Street 1:242 KING AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-475-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN297760367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife