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NPI Code Detail

MEDICARE: MRS. ANDREA BRAXTON RN

MEDICARE: MRS. ANDREA BRAXTON RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse160853WI

General Provider Information

NPI Number : 1912315656
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANDREA BRAXTON RN
Provider Business Mailing Address
First Line : 3914 DALLAS DR
Second Line :
City : MADISON
State : WI
Zip : 53719-1879
Country : US
Telephone Number : 608-695-8087
Fax Number :
Provider Business Practice Location Address
First Line : 3914 DALLAS DR
Second Line :
City : MADISON
State : WI
Zip : 53719-1879
Country : US
Telephone Number : 608-695-8087
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2014
Last Update Date : 07/25/2014

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Directions to “ MRS. ANDREA BRAXTON RN” Practice Location

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