Provider Demographics
NPI:1598971715
Name:BRAZE, BERNADETTE ACDAN (DO)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ACDAN
Last Name:BRAZE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:BERNADETTE
Other - Middle Name:ACDAN
Other - Last Name:BRAZE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1739 E BEVERLY AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-263-4722
Mailing Address - Fax:928-263-4794
Practice Address - Street 1:361 ALEXANDER SPRING RD
Practice Address - Street 2:CARLISLE REGIONAL MEDICAL CENTER
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-6940
Practice Address - Country:US
Practice Address - Phone:717-249-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015748207YS0123X
AZ6229207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery