Healthcare Provider Details

I. General information

NPI: 1033045729
Provider Name (Legal Business Name): LEIGH BRAUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 15TH PL
KENOSHA WI
53140-4947
US

IV. Provider business mailing address

3738 WARREN CIR
MOUNT PLEASANT WI
53405-4927
US

V. Phone/Fax

Practice location:
  • Phone: 262-551-2700
  • Fax:
Mailing address:
  • Phone: 414-334-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number18393-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: