Provider Demographics
NPI:1326809104
Name:RAIDER, BRANDEN WAYNE (RN)
Entity Type:Individual
Prefix:
First Name:BRANDEN
Middle Name:WAYNE
Last Name:RAIDER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5913 ELDORADO AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1350
Mailing Address - Country:US
Mailing Address - Phone:859-559-5194
Mailing Address - Fax:
Practice Address - Street 1:5913 ELDORADO AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1350
Practice Address - Country:US
Practice Address - Phone:859-559-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1159821163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency