Provider Demographics
NPI:1598967481
Name:BRADEN, NANCY JO (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JO
Last Name:BRADEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W SURREY AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1822
Mailing Address - Country:US
Mailing Address - Phone:602-863-1226
Mailing Address - Fax:
Practice Address - Street 1:2 W SURREY AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1822
Practice Address - Country:US
Practice Address - Phone:602-863-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16347208000000X, 208U00000X
OH35051615208000000X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAB3167055OtherDEA