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General NPI Number Information
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NPI Number | 1336604644
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Entity Type | Individual
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Provider Name | NICOLE BRAZG NP
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Gender | Female
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Dates
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Enumeration Date | 01/31/2019
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 225 E CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 425-445-1865
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Fax |
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Provider Business Mailing Address
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Address Line | 33 W ONTARIO ST APT 52F
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City | CHICAGO
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State | IL
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Zip | 60654-7775
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Country | US
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Telephone | 425-445-1865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN60905606
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041465583
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP60916521
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209018362
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License Number State | IL
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