Provider Demographics
NPI:1861101701
Name:BRAATEN, JANDI (FNP)
Entity type:Individual
Prefix:
First Name:JANDI
Middle Name:
Last Name:BRAATEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 LABUDDE AVE NE
Mailing Address - Street 2:
Mailing Address - City:BAGLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56621-8708
Mailing Address - Country:US
Mailing Address - Phone:218-407-7618
Mailing Address - Fax:
Practice Address - Street 1:3922 BARRING TRCE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2500
Practice Address - Country:US
Practice Address - Phone:309-692-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine