Provider Demographics
NPI:1407891112
Name:BRAUN, MANDI L (PA-C)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:L
Last Name:BRAUN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MANDI
Other - Middle Name:
Other - Last Name:SPLONSKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4516
Mailing Address - Country:US
Mailing Address - Phone:701-530-7500
Mailing Address - Fax:701-530-7484
Practice Address - Street 1:310 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4516
Practice Address - Country:US
Practice Address - Phone:701-530-7500
Practice Address - Fax:701-530-7484
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP76927OtherHEALTHPARTNERS
ND1044404OtherPREFERRED ONE
MN225420100Medicaid
MN225420100Medicaid
ND1044404OtherPREFERRED ONE
MN970003023Medicare PIN
P67731Medicare UPIN
MNP00424105Medicare PIN