Provider Demographics
NPI:1831466143
Name:BRAUER DEVER, RACHEL MICHELLE (NP-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MICHELLE
Last Name:BRAUER DEVER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1458
Mailing Address - Country:US
Mailing Address - Phone:219-880-6369
Mailing Address - Fax:
Practice Address - Street 1:11200 LINCOLN HIGHWAY
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448
Practice Address - Country:US
Practice Address - Phone:815-464-2171
Practice Address - Fax:401-652-0619
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28174281A363LF0000X
IL209009233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily