Provider Demographics
NPI:1295703163
Name:BRAUER, PAULETTE J
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:J
Last Name:BRAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6037 WILLIAMSBURG PKWY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-3055
Practice Address - Country:US
Practice Address - Phone:410-548-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR104777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403783900Medicaid
MD62149201OtherCAREFIRST BC OF MD IND #
DC0078OtherCAREFIRST BC OF NCA IND #
MD62149201OtherCAREFIRST BC OF MD IND #
MD403783900Medicaid
DE249862YFAZMedicare PIN