MEDICARE: CHRISTINE BRAZZELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1215267489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE BRAZZELL

Provider Business Mailing Address
First Line	:	101 W MUHAMMAD ALI BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8040 NEW LAGRANGE ROAD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-4764
Country	:	US
Telephone Number	:	502-589-8600
Fax Number	:	502-589-8771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2010
Last Update Date	:	01/11/2010

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Directions to “ CHRISTINE BRAZZELL ” Practice Location

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