Healthcare Provider Details

I. General information

NPI: 1174640437
Provider Name (Legal Business Name): ANN CECELIA BRAATEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N1797 MAPLE TERRACE RD
GREENVILLE WI
54942-8730
US

IV. Provider business mailing address

N1797 MAPLE TERRACE RD
GREENVILLE WI
54942-8730
US

V. Phone/Fax

Practice location:
  • Phone: 920-235-4910
  • Fax: 920-237-2046
Mailing address:
  • Phone: 920-235-4910
  • Fax: 920-237-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number12289-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: