Provider Demographics
NPI:1699207589
Name:BRAZO, KARAN (LPN)
Entity Type:Individual
Prefix:
First Name:KARAN
Middle Name:
Last Name:BRAZO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 DIXON RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:13026-9708
Mailing Address - Country:US
Mailing Address - Phone:315-604-7897
Mailing Address - Fax:
Practice Address - Street 1:2695 DIXON RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NY
Practice Address - Zip Code:13026-9708
Practice Address - Country:US
Practice Address - Phone:315-604-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326381164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse