Healthcare Provider Details

I. General information

NPI: 1699504761
Provider Name (Legal Business Name): ERIN THERESA BRAXTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA RD STE 202
NEWARK DE
19713-4221
US

IV. Provider business mailing address

33 LEOPARD RD
BERWYN PA
19312-1882
US

V. Phone/Fax

Practice location:
  • Phone: 302-366-7671
  • Fax:
Mailing address:
  • Phone: 610-209-7042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: