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General NPI Number Information
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NPI Number | 1659183416
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Entity Type | Individual
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Provider Name | CHRISTINA NANCY BRADDOCK
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 66-498 KILIOE PL
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City | HALEIWA
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State | HI
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Zip | 96712-1429
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Country | US
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Telephone | 808-212-9922
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Fax |
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Provider Business Mailing Address
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Address Line | 66-498 KILIOE PL
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City | HALEIWA
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State | HI
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Zip | 96712-1429
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Country | US
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Telephone | 808-212-9922
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-4970
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License Number State | HI
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