Provider Demographics
NPI:1669682753
Name:BRAUN, IVY (PNP)
Entity Type:Individual
Prefix:MS
First Name:IVY
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-1111
Mailing Address - Country:US
Mailing Address - Phone:914-629-9667
Mailing Address - Fax:
Practice Address - Street 1:ROBERT APPLEBY SBHC AT NORWALK HS
Practice Address - Street 2:1 PARK STREET
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-838-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380802363LP0200X
CT8648363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics