Provider Demographics
NPI:1730363292
Name:BRAKER, JEANETTE MARIE (RN, PHN)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MARIE
Last Name:BRAKER
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:MARIE
Other - Last Name:STEFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:597 CENTER AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4640
Mailing Address - Country:US
Mailing Address - Phone:925-313-6277
Mailing Address - Fax:925-313-6029
Practice Address - Street 1:597 CENTER AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4640
Practice Address - Country:US
Practice Address - Phone:925-313-6277
Practice Address - Fax:925-313-6029
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302370163W00000X, 163WA2000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management