Provider Demographics
NPI:1497896955
Name:SALTER BRAUN, NICOLE M (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:SALTER BRAUN
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:BRAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6588
Mailing Address - Fax:608-756-4704
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548
Practice Address - Country:US
Practice Address - Phone:608-756-6588
Practice Address - Fax:608-756-4704
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI137222-030163WH0200X
IL209.009060363LF0000X
WI4863-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1497896955OtherBCBSWI
WI1497896955Medicaid
WIBRAUNNICOtherMERCYCARE INSURANCE
WIK400322507-000054176Medicare PIN