Provider Demographics
NPI:1942068267
Name:KIM-BRAXTON, CYANNA M
Entity Type:Individual
Prefix:
First Name:CYANNA
Middle Name:M
Last Name:KIM-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 1:2902 ERIE ST SE # 65
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3143
Mailing Address - Country:US
Mailing Address - Phone:202-378-0994
Mailing Address - Fax:
Practice Address - Street 1:2902 ERIE ST SE # 65
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3143
Practice Address - Country:US
Practice Address - Phone:202-378-0994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003309374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide