Most Relevant Information
Provider Data
| NPI Number: | 1003487638 |
| Provider Name: | BRADEN ASHVIN PHETKHAMCHANH |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/06/2021 |
| Last Updated: | 07/06/2021 |
Provider Practice Location
201 TRUEBLOOD AVE
OSKALOOSA
IA
525771757
Practice Location Phone/Fax
| Phone: | 6416731093 |
| Fax: |
Provider Mailing Location
1917 S STONEYBROOK ST
WICHITA
KS
672077111
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |