Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 0024169633 | VA |
NPI | 1023365335 |
---|---|
Provider Name | Melissa Braun |
First Address | Arlington, VA 22205-1640 |
Second Address | Warrenton, VA 20186-3027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2012 |
Last Update Date | 07/08/2012 |