Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5101015748 | MI |
N | 207YS0123X | Facial Plastic Surgeon | 6229 | AZ |
NPI | 1598971715 |
---|---|
Provider Name | Bernadette Acdan Braze |
First Address | Kingman, AZ 86409-3593 |
Second Address | Carlisle, PA 17015-6940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 06/03/2018 |