Provider Demographics
NPI:1659397412
Name:BRATTON, SALLY ILENE (FNP)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ILENE
Last Name:BRATTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:43600 MISSION BLVD # 16
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5847
Mailing Address - Country:US
Mailing Address - Phone:510-659-6258
Mailing Address - Fax:510-659-6218
Practice Address - Street 1:43600 MISSION BLVD # 16
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5847
Practice Address - Country:US
Practice Address - Phone:510-659-6258
Practice Address - Fax:510-659-6218
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA232999363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool