| Marquitta Crystal Braih Sole Mbr | |
|
739 Ashley Dr Chaska MN 55318-1536 | |
| (952) 856-8408 | |
| Not Available |
| Full Name | Marquitta Crystal Braih Sole Mbr |
|---|---|
| Speciality | Clinic/Center |
| Location | 739 Ashley Dr, Chaska, Minnesota |
| Authorized Official Name and Position | Marquitta Crystal Braih (OWNER) |
| Authorized Official Contact | 9528568408 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marquitta Crystal Braih Sole Mbr 739 Ashley Dr Chaska MN 55318-1536 Ph: (952) 856-8408 | Marquitta Crystal Braih Sole Mbr 739 Ashley Dr Chaska MN 55318-1536 Ph: (952) 856-8408 |
| NPI Number | 1649060237 |
|---|---|
| Provider Enumeration Date | 05/08/2025 |
| Last Update Date | 05/08/2025 |
| Certification Date | 05/07/2025 |
| Medicare PECOS PAC ID | 3375031859 |
|---|---|
| Medicare Enrollment ID | O20251024004060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649060237 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | () | Primary |
| Provider Name | Marquitta Crystal Braih |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376190793 PECOS PAC ID: 8729310636 Enrollment ID: I20191025002028 |
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