Provider Demographics
NPI:1790047983
Name:BRACY, ELIZABETH (MSN, RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BRACY
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:BRACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:15481 W CLUB DELUXE RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1466
Mailing Address - Country:US
Mailing Address - Phone:985-543-4880
Mailing Address - Fax:985-543-4888
Practice Address - Street 1:15481 W CLUB DELUXE RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1466
Practice Address - Country:US
Practice Address - Phone:985-543-4880
Practice Address - Fax:985-543-4888
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN054017163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health