Individual
BRAEDON HAERTLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4121 VETERANS MEMORIAL DR, MOUNT VERNON, IL 62864-6262
(618) 214-8392
Mailing address
4121 VETERANS MEMORIAL DR, MOUNT VERNON, IL 62864-6262
(618) 242-3778
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007253
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085007253
PHYSICIAN ASSISTANT LICENSE
IL
Enumeration date
09/11/2019
Last updated
01/30/2025
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