Provider Demographics
NPI:1558600536
Name:BRAUNWELL, LISA (APN, RN)
Entity Type:Individual
Prefix:PROF
First Name:LISA
Middle Name:
Last Name:BRAUNWELL
Suffix:
Gender:F
Credentials:APN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 INLET AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2518
Mailing Address - Country:US
Mailing Address - Phone:609-618-9199
Mailing Address - Fax:
Practice Address - Street 1:205 INLET AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2518
Practice Address - Country:US
Practice Address - Phone:609-618-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00406800363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics