Provider Demographics
NPI:1285455279
Name:BRALEY, KRISTA (PARAMEDICAL TATTOO)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:BRALEY
Suffix:
Gender:F
Credentials:PARAMEDICAL TATTOO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MAIN RD STE B
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-7130
Mailing Address - Country:US
Mailing Address - Phone:207-951-1908
Mailing Address - Fax:
Practice Address - Street 1:107 MAIN RD STE B
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:ME
Practice Address - Zip Code:04429-7130
Practice Address - Country:US
Practice Address - Phone:207-951-1908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other