Provider Demographics
NPI:1245916006
Name:BRAW BEATHAN LLC
Entity type:Organization
Organization Name:BRAW BEATHAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALM
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:801-946-4740
Mailing Address - Street 1:1399 S 700 E STE 7
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2103
Mailing Address - Country:US
Mailing Address - Phone:385-441-6707
Mailing Address - Fax:
Practice Address - Street 1:1399 S 700 E STE 7
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2103
Practice Address - Country:US
Practice Address - Phone:385-441-6707
Practice Address - Fax:833-471-4568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty