Individual
ANNA ELIZABETH BRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2400 HARTMAN LN, SPRINGFIELD, OR 97477-1118
(541) 334-3350
Mailing address
2400 HARTMAN LN, SPRINGFIELD, OR 97477-1118
(541) 334-3350
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA211508
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA211508
OREGON MEDICAL BOARD
OR
Enumeration date
04/13/2022
Last updated
09/28/2022
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