Provider Demographics
NPI:1619227030
Name:BRASEL, LINDA COOLEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:COOLEY
Last Name:BRASEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N. UNION ST.
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-1124
Mailing Address - Country:US
Mailing Address - Phone:513-734-9050
Mailing Address - Fax:513-734-9051
Practice Address - Street 1:210 N. UNION ST.
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-1124
Practice Address - Country:US
Practice Address - Phone:513-734-9050
Practice Address - Fax:513-734-9051
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003421363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant