Provider Demographics
NPI:1124129200
Name:BRADEN, JEAN LOUISE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:LOUISE
Last Name:BRADEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:LOUISE
Other - Last Name:CHOUINARD-BRADEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:2525 4TH AVENUE NORTH
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:406-248-3637
Mailing Address - Fax:406-254-9330
Practice Address - Street 1:1844 BROADWATER
Practice Address - Street 2:#4
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-656-9980
Practice Address - Fax:406-656-9928
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN13969363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT432822Medicaid
37058OtherBCBS
MT432822Medicaid
81520Medicare ID - Type Unspecified