Provider Demographics
NPI:1174271100
Name:BRADEN, REBECCA DIANE (LPN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:BRADEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:DIANE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:66 PAVILION AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-1522
Mailing Address - Country:US
Mailing Address - Phone:401-461-9110
Mailing Address - Fax:401-461-9194
Practice Address - Street 1:66 PAVILION AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-1522
Practice Address - Country:US
Practice Address - Phone:401-461-9110
Practice Address - Fax:401-461-9194
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILPN10392164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse