Healthcare Provider Details

I. General information

NPI: 1679248397
Provider Name (Legal Business Name): KATELYNNE MARIE BRAFF CST, CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KATIE MARIE BRAFF

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE
STAYTON OR
97383-1399
US

IV. Provider business mailing address

300 UNIVERSITY ST
JEFFERSON OR
97352-9333
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-2175
  • Fax:
Mailing address:
  • Phone: 503-910-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number187696
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number202395
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: