Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R193589 | MD |
NPI | 1134468275 |
---|---|
Provider Name | Dr. Susan Braid |
First Address | Fort Campbell, KY 42223-5349 |
Second Address | Fort Campbell, KY 42223-5349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2013 |
Last Update Date | 24/05/2021 |