Provider Demographics
NPI:1346354818
Name:BRAZELL, DONNA L (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:BRAZELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-782-0097
Practice Address - Street 1:113 WALNUT ST
Practice Address - Street 2:
Practice Address - City:IDALOU
Practice Address - State:TX
Practice Address - Zip Code:79329
Practice Address - Country:US
Practice Address - Phone:806-892-2537
Practice Address - Fax:806-892-2726
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551054163W00000X
TXAP110366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018953203Medicaid
TX131550102OtherFIRST CARE
TX8N7014OtherBLUE CROSS
TX8B3969Medicare ID - Type UnspecifiedMEDICARE
TX131550102OtherFIRST CARE