Provider Demographics
NPI:1679097638
Name:BRAAKSMA, AMY SUE (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:BRAAKSMA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 HIGHLAND BLVD STE 3360
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6914
Mailing Address - Country:US
Mailing Address - Phone:406-587-4242
Mailing Address - Fax:406-587-3507
Practice Address - Street 1:931 HIGHLAND BLVD STE 3360
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6914
Practice Address - Country:US
Practice Address - Phone:406-587-4242
Practice Address - Fax:406-587-3507
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-126846363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner