Individual
MR. SLADE BRACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSN, RN
Contact information
Practice address
3401 I ST FL 5, PHILADELPHIA, PA 19134-1442
(215) 923-8042
Mailing address
423 N 32ND ST APT 1, PHILADELPHIA, PA 19104-4785
(215) 983-1469
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
RN730526
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN730526
RN LICENSE
PA
Enumeration date
09/21/2021
Last updated
09/21/2021
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