Provider Demographics
NPI:1932535903
Name:BRAUER, PATRICK LYNDON (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:LYNDON
Last Name:BRAUER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 RIVERS EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2755
Mailing Address - Country:US
Mailing Address - Phone:715-828-2368
Mailing Address - Fax:509-545-4861
Practice Address - Street 1:1490 RIVERS EDGE TRL
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2755
Practice Address - Country:US
Practice Address - Phone:715-828-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-22
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005856363A00000X
WAPA60400481363AM0700X
WI8041-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical