Provider Demographics
NPI:1497162259
Name:BRASELMAN-WEST, AQUILLINE
Entity Type:Individual
Prefix:MRS
First Name:AQUILLINE
Middle Name:
Last Name:BRASELMAN-WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 N MARGUERITE AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2339
Mailing Address - Country:US
Mailing Address - Phone:314-365-3376
Mailing Address - Fax:314-365-3376
Practice Address - Street 1:35 N MARGUERITE AVE
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2339
Practice Address - Country:US
Practice Address - Phone:314-365-3376
Practice Address - Fax:314-365-3376
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider