Provider Demographics
NPI:1992431985
Name:BRAUN, STACEY ANN
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:BRAUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-4429
Mailing Address - Country:US
Mailing Address - Phone:513-390-0962
Mailing Address - Fax:
Practice Address - Street 1:453 KIRKWOOD DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-4429
Practice Address - Country:US
Practice Address - Phone:513-390-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty