Healthcare Provider Details

I. General information

NPI: 1144109661
Provider Name (Legal Business Name): MICHELE ELISE BRAKE APRN, ACCNS-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 KILDAIRE FARM RD
CARY NC
27518-6616
US

IV. Provider business mailing address

500 CANON GATE DR
CARY NC
27518-2978
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-2603
  • Fax:
Mailing address:
  • Phone: 919-244-6217
  • Fax: 919-244-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number596
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number189789
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: