Healthcare Provider Details

I. General information

NPI: 1295703163
Provider Name (Legal Business Name): PAULETTE J BRAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 COLONIAL DR
DENTON MD
21629-3055
US

IV. Provider business mailing address

6037 WILLIAMSBURG PKWY
SALISBURY MD
21801-2281
US

V. Phone/Fax

Practice location:
  • Phone: 410-548-2343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR104777
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: