Healthcare Provider Details

I. General information

NPI: 1831466143
Provider Name (Legal Business Name): RACHEL MICHELLE BRAUER DEVER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 LINCOLN HIGHWAY
MOKENA IL
60448
US

IV. Provider business mailing address

913 WAVERLY RD
PORTER IN
46304-1458
US

V. Phone/Fax

Practice location:
  • Phone: 815-464-2171
  • Fax: 401-652-0619
Mailing address:
  • Phone: 219-880-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28174281A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209009233
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: