Provider Demographics
NPI:1396820015
Name:BRAUN, GEORGIEANN (NPP)
Entity Type:Individual
Prefix:MISS
First Name:GEORGIEANN
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2709
Mailing Address - Country:US
Mailing Address - Phone:516-889-8844
Mailing Address - Fax:516-889-8857
Practice Address - Street 1:871 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2709
Practice Address - Country:US
Practice Address - Phone:516-889-8844
Practice Address - Fax:516-889-8857
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400428-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02112485Medicaid
NY02112485Medicaid