Provider Demographics
NPI:1518593227
Name:BRAFORD, JODI
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:BRAFORD
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 1:57210 GEARHARTS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8924
Mailing Address - Country:US
Mailing Address - Phone:269-615-1738
Mailing Address - Fax:
Practice Address - Street 1:57210 GEARHARTS LANDING RD
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8924
Practice Address - Country:US
Practice Address - Phone:269-615-1738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704260193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily