Basic Information
| Provider Information | |||||||||
| NPI: | 1598971715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAZE | ||||||||
| FirstName: | BERNADETTE | ||||||||
| MiddleName: | ACDAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DO | ||||||||
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| OtherLastName: | BRAZE | ||||||||
| OtherFirstName: | BERNADETTE | ||||||||
| OtherMiddleName: | ACDAN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1739 E BEVERLY AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864093593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282634722 | ||||||||
| FaxNumber: | 9282634794 | ||||||||
| Practice Location | |||||||||
| Address1: | 361 ALEXANDER SPRING RD | ||||||||
| Address2: | CARLISLE REGIONAL MEDICAL CENTER | ||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170156940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172491212 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 03/06/2018 | ||||||||
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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 | 207YS0123X | 5101015748 | MI | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YS0123X | 6229 | AZ | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
No ID Information.