1871734525 NPI number — MS. CARYN PATRICIA BRAKENRIDGE M.A.

Table of content: MS. CARYN PATRICIA BRAKENRIDGE M.A. (NPI 1871734525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871734525 NPI number — MS. CARYN PATRICIA BRAKENRIDGE M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAKENRIDGE
Provider First Name:
CARYN
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871734525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
354 PLEASANT HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINONA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55987-1364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-846-8348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 FRANKLIN ST
Provider Second Line Business Practice Location Address:
FAMILY & CHILDREN'S CENTER
Provider Business Practice Location Address City Name:
WINONA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55987-3822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-453-9563
Provider Business Practice Location Address Fax Number:
507-453-9562
Provider Enumeration Date:
03/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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