Provider Demographics
NPI:1134149552
Name:BRAATEN, MARIE (NP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:BRAATEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SOUTH CASCADE STREET
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2813
Mailing Address - Country:US
Mailing Address - Phone:218-736-8000
Mailing Address - Fax:218-736-8757
Practice Address - Street 1:712 SOUTH CASCADE STREET
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2813
Practice Address - Country:US
Practice Address - Phone:218-736-8000
Practice Address - Fax:218-736-8757
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0257609-23363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04-12780OtherMEDICA NUMBER
MN1011589OtherPREFERRED ONE NUMBER
ND19848Medicaid
MN29T22BROtherBCBS NUMBER
MNHP26497OtherHEALTHPARTNERS NUMBER
MN123438OtherUCARE NUMBER
MN747022300Medicaid
S26885Medicare UPIN
MN1011589OtherPREFERRED ONE NUMBER
MN500001522Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
MN747022300Medicaid