Provider Demographics
NPI:1669590394
Name:BRAUKMAN, MARK (MA, CN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BRAUKMAN
Suffix:
Gender:M
Credentials:MA, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S ADAMS WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4909
Mailing Address - Country:US
Mailing Address - Phone:303-722-3234
Mailing Address - Fax:
Practice Address - Street 1:950 S ADAMS WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4909
Practice Address - Country:US
Practice Address - Phone:303-722-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist