Provider Demographics
NPI:1326374430
Name:BRAIN, AVERY (RN)
Entity Type:Individual
Prefix:MS
First Name:AVERY
Middle Name:
Last Name:BRAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 E BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7852
Mailing Address - Country:US
Mailing Address - Phone:928-527-5502
Mailing Address - Fax:
Practice Address - Street 1:3950 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-7852
Practice Address - Country:US
Practice Address - Phone:928-527-5502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN082662163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool