Provider Demographics
NPI:1114523107
Name:BRASWELL, IRMA
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:BRASWELL
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 1:96 TOMMY STALNAKER DR STE B
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9236
Mailing Address - Country:US
Mailing Address - Phone:478-333-2735
Mailing Address - Fax:478-845-7390
Practice Address - Street 1:96 TOMMY STALNAKER DR STE B
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9236
Practice Address - Country:US
Practice Address - Phone:478-333-2735
Practice Address - Fax:478-845-7390
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN014684164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse