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General NPI Number Information
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NPI Number | 1003068552
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Entity Type | Individual
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Provider Name | WANDA LAVERNE MCGOWAN-BRAYNEN ARNP
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Gender | Female
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-585-1111
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Fax | 305-999-9941
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Provider Business Mailing Address
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Address Line | 20315 NW 3RD CT
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-2526
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Country | US
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Telephone | 305-651-2386
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Fax | 305-999-9941
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP1750042
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License Number State | FL
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