Provider Demographics
NPI:1427100577
Name:BRATHWAITE, BRENDA LUISA (CMN)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LUISA
Last Name:BRATHWAITE
Suffix:
Gender:F
Credentials:CMN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E 20TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10009
Mailing Address - Country:US
Mailing Address - Phone:212-995-2477
Mailing Address - Fax:
Practice Address - Street 1:1111 AMSTERDAM AVE CLARK 2
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-523-5587
Practice Address - Fax:212-523-1723
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY388500 1163W00000X
NY000502176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered176B00000XOther Service ProvidersMidwife