Provider Demographics
NPI:1780200113
Name:BRAUNGARDT, HANNAH JO (DO)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:JO
Last Name:BRAUNGARDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:HANNAH
Other - Middle Name:JO BRAUNGARDT
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MO
Mailing Address - Zip Code:63537-1335
Mailing Address - Country:US
Mailing Address - Phone:660-397-3517
Mailing Address - Fax:660-397-2307
Practice Address - Street 1:104 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MO
Practice Address - Zip Code:63537-1335
Practice Address - Country:US
Practice Address - Phone:660-397-3517
Practice Address - Fax:660-397-2307
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023025344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine