Healthcare Provider Details

I. General information

NPI: 1871181685
Provider Name (Legal Business Name): BRAEDE MERRILL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRAEDE WILCOX DO

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX 1600
FPO AP
96362-0017
US

IV. Provider business mailing address

PSC 482 BOX 1600
FPO AP
96362-0017
US

V. Phone/Fax

Practice location:
  • Phone: 98-971-7555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61582406
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: