Individual
MR. BRADEN STANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1222 PRAY BLVD, WATERVILLE, OH 43566-8717
(419) 344-8176
Mailing address
1222 PRAY BLVD, WATERVILLE, OH 43566-8717
(419) 344-8176
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.440269
OH
363LF0000X
Family Nurse Practitioner
4704377772NSA210E8
MI
363LF0000X
Family Nurse Practitioner
Primary
APRN.CNP.0029093
MI
Other
Enumeration date
05/18/2021
Last updated
10/12/2024
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