MEDICARE: BRADEN WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	00969999	SD

General Provider Information

NPI Number	:	1295278356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADEN WILLIAMS

Provider Business Mailing Address
First Line	:	6123 COVENANT DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-9524
Country	:	US
Telephone Number	:	605-430-2492
Fax Number	:

Provider Business Practice Location Address
First Line	:	6123 COVENANT DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-9524
Country	:	US
Telephone Number	:	605-430-2492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	06/29/2023

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Directions to “ BRADEN WILLIAMS ” Practice Location

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