MEDICARE: RODNEY M BRAUHER LMSW, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801059465	MI
2	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1831132810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNEY M BRAUHER LMSW, PA-C

Provider Business Mailing Address
First Line	:	5781 GRAND RIVER DR
Second Line	:
City	:	GRAND LEDGE
State	:	MI
Zip	:	48837-8958
Country	:	US
Telephone Number	:	517-622-2912
Fax Number	:	517-622-2912

Provider Business Practice Location Address
First Line	:	1451 RIVER PARK DR STE 260
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4504
Country	:	US
Telephone Number	:	657-400-5180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	10/28/2019

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