Provider Demographics
NPI:1831628320
Name:BRAUGHTON, REBECCA (MS, APN, CPNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BRAUGHTON
Suffix:
Gender:F
Credentials:MS, APN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8653 DENA CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-0400
Mailing Address - Country:US
Mailing Address - Phone:773-263-0487
Mailing Address - Fax:
Practice Address - Street 1:6750 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-1646
Practice Address - Country:US
Practice Address - Phone:219-803-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007165A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics