Individual
SHAELYN BRAENOVICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
175 PHILPOTT LN, BEAVER, WV 25813-9501
(304) 254-9262
Mailing address
175 PHILPOTT LN, BEAVER, WV 25813-9501
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
119461
WV
164W00000X
Licensed Practical Nurse
39816
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39816
—
WV
Enumeration date
02/01/2023
Last updated
09/05/2024
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