Provider Demographics
NPI:1619973278
Name:BRAVERMAN, BARBARA (CRNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD YORK RD
Mailing Address - Street 2:STE 203
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2872
Mailing Address - Country:US
Mailing Address - Phone:215-886-0174
Mailing Address - Fax:215-886-9217
Practice Address - Street 1:500 OLD YORK RD
Practice Address - Street 2:STE 203
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2872
Practice Address - Country:US
Practice Address - Phone:215-886-0174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005045C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA453724Medicare PIN