Provider Demographics
NPI:1083220768
Name:VANBRAKLE, VITA VERENA
Entity Type:Individual
Prefix:
First Name:VITA
Middle Name:VERENA
Last Name:VANBRAKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MCDONALD PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2331
Mailing Address - Country:US
Mailing Address - Phone:202-422-8770
Mailing Address - Fax:
Practice Address - Street 1:128 WEBSTER ST NW # 13C
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7335
Practice Address - Country:US
Practice Address - Phone:202-321-4893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant