Provider Demographics
NPI:1639650815
Name:BRAXTON, TAMEISHA
Entity Type:Individual
Prefix:
First Name:TAMEISHA
Middle Name:
Last Name:BRAXTON
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 1:17230 TOEPFER DR
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3014
Mailing Address - Country:US
Mailing Address - Phone:586-252-8014
Mailing Address - Fax:
Practice Address - Street 1:21250 HARPER AVE # 3
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2221
Practice Address - Country:US
Practice Address - Phone:586-533-2483
Practice Address - Fax:586-359-6160
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide