Individual
ALICE E BRAYSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1255 LIBERTY STREET, REDDING, CA 96001-0814
(530) 246-2467
(530) 242-9460
Mailing address
PO BOX 991950, REDDING, CA 96099-1950
(530) 246-2467
(530) 242-9460
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA18032
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680310525
TAX ID
CA
05
—
GR0079250
—
CA
01
—
PA18032
PA LICENSE NUMBER
CA
Enumeration date
11/09/2006
Last updated
07/27/2012
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