Provider Demographics
NPI:1700208758
Name:BRATTON, MAKEBA
Entity Type:Individual
Prefix:
First Name:MAKEBA
Middle Name:
Last Name:BRATTON
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 1:34 BLUE BARNS RD
Mailing Address - Street 2:
Mailing Address - City:REXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12148-1158
Mailing Address - Country:US
Mailing Address - Phone:518-364-5191
Mailing Address - Fax:
Practice Address - Street 1:34 BLUE BARNS RD
Practice Address - Street 2:
Practice Address - City:REXFORD
Practice Address - State:NY
Practice Address - Zip Code:12148-1158
Practice Address - Country:US
Practice Address - Phone:518-364-5191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308827164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse