Provider Demographics
NPI:1093543662
Name:BRAUCHT, OLIVIA MARIE (NP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:BRAUCHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 GOSHAWK DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-3608
Mailing Address - Country:US
Mailing Address - Phone:949-303-9290
Mailing Address - Fax:
Practice Address - Street 1:1113 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5591
Practice Address - Country:US
Practice Address - Phone:970-449-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily