Provider Demographics
NPI:1316328909
Name:BRAUER, SHELBY DANIELLE (CNM)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:DANIELLE
Last Name:BRAUER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:DANIELLE
Other - Last Name:HARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16777 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3254
Mailing Address - Country:US
Mailing Address - Phone:225-761-8223
Mailing Address - Fax:225-761-5220
Practice Address - Street 1:16777 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3254
Practice Address - Country:US
Practice Address - Phone:225-761-8223
Practice Address - Fax:225-761-5220
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA138443-8295367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2405241Medicaid
MS07731876Medicaid
LA2405241Medicaid