Provider Demographics
NPI:1124334891
Name:BRASWELL, PETER (RN)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:BRASWELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:BUILDING # 2059, ATTN: MCXE-PM-CH
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4603
Mailing Address - Country:US
Mailing Address - Phone:719-526-2939
Mailing Address - Fax:719-526-7181
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:BUILDING # 2059, ATTN: MCXE-PM-CH
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-526-2939
Practice Address - Fax:719-526-7181
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX744185163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health