Provider Demographics
NPI:1134732829
Name:BRAYTON, TRACEY MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:MARIE
Last Name:BRAYTON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1530
Mailing Address - Country:US
Mailing Address - Phone:518-747-8001
Mailing Address - Fax:518-747-8003
Practice Address - Street 1:340 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1530
Practice Address - Country:US
Practice Address - Phone:518-747-8001
Practice Address - Fax:518-747-8003
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY507704163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty