Provider Demographics
NPI:1073187084
Name:BRAZIL-MENARD, ANGELA ROSE (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ROSE
Last Name:BRAZIL-MENARD
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 DAY DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4425
Mailing Address - Country:US
Mailing Address - Phone:650-888-7612
Mailing Address - Fax:
Practice Address - Street 1:11901 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3421
Practice Address - Country:US
Practice Address - Phone:402-401-6151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty