Provider Demographics
NPI:1578192282
Name:BRACKNELL, LAURA B (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:BRACKNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-255-7938
Mailing Address - Fax:440-255-9196
Practice Address - Street 1:8655 MARKET STREET
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-255-7938
Practice Address - Fax:440-255-9196
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine