Provider Demographics
NPI:1063536829
Name:BRAUN, LISA (MED, LAT, ATC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:MED, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 POPLAR
Mailing Address - Street 2:
Mailing Address - City:BURDEN
Mailing Address - State:KS
Mailing Address - Zip Code:67019
Mailing Address - Country:US
Mailing Address - Phone:620-229-6226
Mailing Address - Fax:
Practice Address - Street 1:421 POPLAR ST
Practice Address - Street 2:
Practice Address - City:BURDEN
Practice Address - State:KS
Practice Address - Zip Code:67019-9416
Practice Address - Country:US
Practice Address - Phone:620-229-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer