Provider Demographics
NPI:1487546404
Name:BRAITHWAITE, HOLLY (CSFA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BRAITHWAITE
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:CROCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:PO BOX 1362
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-7862
Mailing Address - Country:US
Mailing Address - Phone:540-336-4947
Mailing Address - Fax:
Practice Address - Street 1:190 CAMPUS BLVD STE 310
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-336-4947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136000351246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant