Provider Demographics
NPI:1649043514
Name:BRAUN, ALEATHIA REANN (BSN, RN)
Entity type:Individual
Prefix:
First Name:ALEATHIA
Middle Name:REANN
Last Name:BRAUN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W VALLEY VIEW RD SPC 23
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9536
Mailing Address - Country:US
Mailing Address - Phone:503-833-2635
Mailing Address - Fax:
Practice Address - Street 1:4610 E SOUTHCROSS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-4914
Practice Address - Country:US
Practice Address - Phone:211-064-8149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201505702RN163W00000X
TX919773163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse