Provider Demographics
NPI:1083264287
Name:ESPINOSA-BRATTEN, MAYRA MIREYA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:MIREYA
Last Name:ESPINOSA-BRATTEN
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 1:21010 ELM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-9789
Mailing Address - Country:US
Mailing Address - Phone:816-805-8769
Mailing Address - Fax:
Practice Address - Street 1:21010 ELM GROVE RD
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-9789
Practice Address - Country:US
Practice Address - Phone:816-805-8769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006032268163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse