Individual
CRYSTAL BRAXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
206 W 17TH ST, RESERVE, LA 70084-6232
(504) 346-1976
Mailing address
206 W 17TH ST, RESERVE, LA 70084-6232
(504) 346-1976
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
008917938
LA
Other
Enumeration date
01/16/2025
Last updated
01/16/2025
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