Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704243236 | MI |
NPI | 1053882209 |
---|---|
Provider Name | Jamie Lynn Braden |
First Address | Flint, MI 48504-4730 |
Second Address | Flint, MI 48504-4730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2018 |
Last Update Date | 18/06/2020 |