Provider Demographics
NPI:1861836975
Name:BRAUTIGAM, NORBEL AUXILIADORA (PA-C)
Entity Type:Individual
Prefix:
First Name:NORBEL
Middle Name:AUXILIADORA
Last Name:BRAUTIGAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8200
Mailing Address - Country:US
Mailing Address - Phone:515-241-2400
Mailing Address - Fax:515-241-2401
Practice Address - Street 1:6000 UNIVERSITY AVE STE 300
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8200
Practice Address - Country:US
Practice Address - Phone:515-241-2400
Practice Address - Fax:515-241-2401
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088490363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1861836975Medicaid
VAVVB448AMedicare PIN