Healthcare Provider Details

I. General information

NPI: 1578868550
Provider Name (Legal Business Name): JOSEPH J BRAKE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BERNVILLE ROAD
READING PA
19605-9453
US

IV. Provider business mailing address

169 MARTIN AVE PO BOX 1002
EPHRATA PA
17522-1724
US

V. Phone/Fax

Practice location:
  • Phone: 610-378-2055
  • Fax: 610-378-2058
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN510383L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: