Provider Demographics
NPI:1962272575
Name:BREAULT, ERIKA (CHW)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:BREAULT
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 KERN RD
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-8008
Mailing Address - Country:US
Mailing Address - Phone:989-426-9431
Mailing Address - Fax:989-426-6952
Practice Address - Street 1:103 N BOWERY STREET
Practice Address - Street 2:GLADWIN, MI 48624
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624
Practice Address - Country:US
Practice Address - Phone:989-430-8249
Practice Address - Fax:989-426-6952
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker