MEDICARE: ELIZABETH BRAZIEL

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	164W00000X	Licensed Practical Nurse	337723	TX

General Provider Information

NPI Number	:	1861030355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BRAZIEL

Provider Business Mailing Address
First Line	:	3433 DANA GREY DR UNIT A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-2208
Country	:	US
Telephone Number	:	760-607-2437
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 DANA GREY DR UNIT A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79938-2208
Country	:	US
Telephone Number	:	760-607-2437
Fax Number	:

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

Provider Enumeration Date	:	12/15/2019
Last Update Date	:	12/15/2019

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Directions to “ ELIZABETH BRAZIEL ” Practice Location

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