Provider Demographics
NPI:1972087146
Name:BRAXTON, FELISH DESHA (RN)
Entity Type:Individual
Prefix:
First Name:FELISH
Middle Name:DESHA
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E OLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-1434
Mailing Address - Country:US
Mailing Address - Phone:608-807-1428
Mailing Address - Fax:608-807-1429
Practice Address - Street 1:210 E OLIN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1434
Practice Address - Country:US
Practice Address - Phone:608-807-1428
Practice Address - Fax:608-807-1429
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229046-30163W00000X
WI229046101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse