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General NPI Number Information
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NPI Number | 1861101701
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Entity Type | Individual
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Provider Name | JANDI BRAATEN FNP
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Gender | Female
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 3922 BARRING TRCE
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City | PEORIA
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State | IL
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Zip | 61615-2500
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Country | US
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Telephone | 309-692-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 501 LABUDDE AVE NE
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City | BAGLEY
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State | MN
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Zip | 56621-8708
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Country | US
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Telephone | 218-407-7618
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9645
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License Number State | MN
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