Provider Demographics
NPI:1609664846
Name:NICHOLS, BREANNA EIDSON (DO)
Entity type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:EIDSON
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:CLAYTON
Other - Last Name:EIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STUDENT
Mailing Address - Street 1:1350 N WEBB WAY APT O309
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1188
Mailing Address - Country:US
Mailing Address - Phone:404-955-3832
Mailing Address - Fax:
Practice Address - Street 1:2335 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program