Healthcare Provider Details

I. General information

NPI: 1588073548
Provider Name (Legal Business Name): MRS. WILMA BRAUNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6947 CHEROKEE DR
SEDALIA CO
80135-8917
US

IV. Provider business mailing address

6947 CHEROKEE DR
SEDALIA CO
80135-8917
US

V. Phone/Fax

Practice location:
  • Phone: 303-688-3882
  • Fax:
Mailing address:
  • Phone: 303-688-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0129241
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: