Healthcare Provider Details

I. General information

NPI: 1881647485
Provider Name (Legal Business Name): JULIENNE RENAE BRAUER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 10TH AVE NE
DEER RIVER MN
56636-8703
US

IV. Provider business mailing address

1025 10TH AVE NE
DEER RIVER MN
56636-8703
US

V. Phone/Fax

Practice location:
  • Phone: 218-246-8275
  • Fax:
Mailing address:
  • Phone: 218-246-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9643
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: