Provider Demographics
NPI:1134925662
Name:BRAKE, DANIEL CHRISTIAN ISAIAH
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CHRISTIAN ISAIAH
Last Name:BRAKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-1920
Mailing Address - Country:US
Mailing Address - Phone:909-767-1147
Mailing Address - Fax:
Practice Address - Street 1:173 S 5TH ST
Practice Address - Street 2:
Practice Address - City:DAVID CITY
Practice Address - State:NE
Practice Address - Zip Code:68632-1920
Practice Address - Country:US
Practice Address - Phone:909-767-1147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion