Provider Demographics
NPI:1972681245
Name:BRAUN, KRISTEN (NP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BRAUN
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 1:302 SAINT JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3506
Mailing Address - Country:US
Mailing Address - Phone:309-664-3100
Mailing Address - Fax:309-664-3027
Practice Address - Street 1:302 SAINT JOSEPH DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3506
Practice Address - Country:US
Practice Address - Phone:309-664-3100
Practice Address - Fax:309-664-3027
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000460363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2613OtherMEDICARE GROUP #
ILP73510Medicare UPIN
IL2613028Medicare PIN