Provider Demographics
NPI:1437814308
Name:BRAUN, CHANNING
Entity Type:Individual
Prefix:MISS
First Name:CHANNING
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 KELLY AVE NE APT 3
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-1846
Mailing Address - Country:US
Mailing Address - Phone:701-333-8561
Mailing Address - Fax:
Practice Address - Street 1:1130 KELLY AVE NE APT 3
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-1846
Practice Address - Country:US
Practice Address - Phone:701-333-8561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant