Provider Demographics
NPI:1871975151
Name:BRACE, KAREN (PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BRACE
Suffix:
Gender:F
Credentials:PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 CORPORATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4975
Mailing Address - Country:US
Mailing Address - Phone:757-455-5009
Mailing Address - Fax:757-362-3577
Practice Address - Street 1:241 CORPORATE BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4975
Practice Address - Country:US
Practice Address - Phone:757-455-5009
Practice Address - Fax:757-362-3577
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VATPC-2669174400000X
VA1204018470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist