Provider Demographics
NPI:1619078128
Name:BRAVERMAN, SUSAN KAY (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:BRAVERMAN
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 1:200 E SMOKE TREE LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-4468
Mailing Address - Country:US
Mailing Address - Phone:928-541-1600
Mailing Address - Fax:
Practice Address - Street 1:146 S GRANITE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4710
Practice Address - Country:US
Practice Address - Phone:928-717-3241
Practice Address - Fax:928-717-3298
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN111484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse