Provider Demographics
NPI:1073999868
Name:BRAET, CARRIE (PNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BRAET
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:500 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1014
Mailing Address - Country:US
Mailing Address - Phone:563-336-3000
Mailing Address - Fax:563-336-3125
Practice Address - Street 1:500 W RIVER DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52801-1014
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:563-336-3125
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC-139877363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAPENDINGMedicaid
IAPENDINGMedicaid