Provider Demographics
NPI:1720314586
Name:BRASWELL, GLORIA JEAN
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:JEAN
Other - Last Name:CHAFFEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-0293
Mailing Address - Country:US
Mailing Address - Phone:269-427-9006
Mailing Address - Fax:
Practice Address - Street 1:223 HARBOR LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:FENNVILLE
Practice Address - State:MI
Practice Address - Zip Code:49408
Practice Address - Country:US
Practice Address - Phone:269-857-8636
Practice Address - Fax:269-857-8636
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion