Basic Information
| Provider Information | |||||||||
| NPI: | 1831466143 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAUER DEVER | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 913 WAVERLY RD | ||||||||
| Address2: | |||||||||
| City: | PORTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463041458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198806369 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11200 LINCOLN HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | MOKENA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154642171 | ||||||||
| FaxNumber: | 4016520619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2011 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 28174281A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 209009233 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.