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General NPI Number Information
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NPI Number | 1932535903
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Entity Type | Individual
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Provider Name | PATRICK LYNDON BRAUER PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/22/2013
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 1490 RIVERS EDGE TRL
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City | ALTOONA
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State | WI
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Zip | 54720-2755
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Country | US
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Telephone | 715-828-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 1490 RIVERS EDGE TRL
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City | ALTOONA
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State | WI
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Zip | 54720-2755
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Country | US
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Telephone | 715-828-2368
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Fax | 509-545-4861
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0005856
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA60400481
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8041-23
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License Number State | WI
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