Provider Demographics
NPI:1639615305
Name:BRAXTON, CHARLOTTE (RN)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
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:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-0479
Mailing Address - Country:US
Mailing Address - Phone:609-579-0594
Mailing Address - Fax:
Practice Address - Street 1:9201 E MOUNTAIN VIEW RD
Practice Address - Street 2:SUITE 220
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5199
Practice Address - Country:US
Practice Address - Phone:480-862-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08987200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse