Provider Demographics
NPI:1679391148
Name:BRADEN, ELLIE
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:BRADEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BEACON ROCK DR
Mailing Address - Street 2:
Mailing Address - City:LAUGHLIN
Mailing Address - State:NV
Mailing Address - Zip Code:89029-1002
Mailing Address - Country:US
Mailing Address - Phone:725-246-6727
Mailing Address - Fax:
Practice Address - Street 1:2801 BEACON ROCK DR
Practice Address - Street 2:
Practice Address - City:LAUGHLIN
Practice Address - State:NV
Practice Address - Zip Code:89029-1002
Practice Address - Country:US
Practice Address - Phone:725-246-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant