Provider Demographics
NPI:1164650818
Name:BRAKEFIELD, KATHERINE CAROL (RN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CAROL
Last Name:BRAKEFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:CAROL
Other - Last Name:PRELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3937 GUSTY CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-4595
Mailing Address - Country:US
Mailing Address - Phone:541-704-8772
Mailing Address - Fax:
Practice Address - Street 1:1046 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1916
Practice Address - Country:US
Practice Address - Phone:541-812-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200741568RN163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical