Basic Information
| Provider Information | |||||||||
| NPI: | 1215973235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADEN | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2000 | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125342000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188288363 | ||||||||
| FaxNumber: | 5186973388 | ||||||||
| Practice Location | |||||||||
| Address1: | 146 JEFFERSON HTS | ||||||||
| Address2: | |||||||||
| City: | CATSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124141215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189433415 | ||||||||
| FaxNumber: | 5189430938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F331841 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 02210819 | 05 | NY | MEDICAID |