Provider Demographics
NPI:1316600364
Name:BRAUTIGAM, SETH D (CRNP)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:D
Last Name:BRAUTIGAM
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 825624
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5624
Mailing Address - Country:US
Mailing Address - Phone:484-628-5820
Mailing Address - Fax:
Practice Address - Street 1:301 S 7TH AVE STE 1120
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1493
Practice Address - Country:US
Practice Address - Phone:484-628-0580
Practice Address - Fax:610-374-1902
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024508363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner