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General NPI Number Information
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NPI Number | 1164018008
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Entity Type | Individual
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Provider Name | BRIANNA LEIGH RAAB PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/15/2020
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 610 TAYLOR ST
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City | DELTA
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State | OH
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Zip | 43515-1046
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Country | US
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Telephone | 419-277-2837
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 COLUMBIA AVE E
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City | BATTLE CREEK
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State | MI
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Zip | 49014-5159
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5601010336
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License Number State | MI
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