Basic Information
| Provider Information | |||||||||
| NPI: | 1922752989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAXTON | ||||||||
| FirstName: | BRITANY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | HAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 WELLNESS BLVD STE 112 | ||||||||
| Address2: | |||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290632873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037651919 | ||||||||
| FaxNumber: | 8038498875 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 WELLNESS BLVD STE 112 | ||||||||
| Address2: | |||||||||
| City: | IRMO | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290632873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037651919 | ||||||||
| FaxNumber: | 8038498875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2022 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 0713 | SC | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.