MEDICARE: MARY M BRACHA APRN

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	363L00000X	Nurse Practitioner	SP019005	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568915171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY M BRACHA APRN

Provider Business Mailing Address
First Line	:	10330 N MERIDIAN ST # 300
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 RACE STREET
Second Line	:	APT1001
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-0000
Country	:	US
Telephone Number	:	610-619-8590
Fax Number	:

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

Provider Enumeration Date	:	07/31/2016
Last Update Date	:	02/18/2019

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