Healthcare Provider Details

I. General information

NPI: 1083200059
Provider Name (Legal Business Name): TOY'NAISHA BRASWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BURKE GLEN RD
TOLEDO OH
43607-2503
US

IV. Provider business mailing address

617 BURKE GLEN RD
TOLEDO OH
43607-2503
US

V. Phone/Fax

Practice location:
  • Phone: 419-902-7442
  • Fax:
Mailing address:
  • Phone: 419-902-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number0422498
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: