Provider Demographics
NPI:1720663024
Name:BRAIDA, PATRICIA (MSN, RN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BRAIDA
Suffix:
Gender:F
Credentials:MSN, RN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2127
Mailing Address - Country:US
Mailing Address - Phone:630-458-5300
Mailing Address - Fax:
Practice Address - Street 1:630 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2127
Practice Address - Country:US
Practice Address - Phone:630-458-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014780363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty