Healthcare Provider Details

I. General information

NPI: 1770713174
Provider Name (Legal Business Name): NATHAN PATRICK BRAUN RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 WAYZATA BLVD STE 140
MINNEAPOLIS MN
55416-2660
US

IV. Provider business mailing address

5775 WAYZATA BLVD STE 140
MINNEAPOLIS MN
55416-2660
US

V. Phone/Fax

Practice location:
  • Phone: 952-738-4477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number06MN1226
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: