Provider Demographics
NPI:1790932721
Name:BRAZIN, ELAINE LUKASAVITZ (RN BSN MSN CNM)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:LUKASAVITZ
Last Name:BRAZIN
Suffix:
Gender:F
Credentials:RN BSN MSN CNM
Other - Prefix:MS
Other - First Name:ELAINE
Other - Middle Name:GAYLE
Other - Last Name:LUKASAVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3673
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106
Mailing Address - Country:US
Mailing Address - Phone:734-973-0710
Mailing Address - Fax:734-973-0595
Practice Address - Street 1:3100 PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104
Practice Address - Country:US
Practice Address - Phone:734-973-0710
Practice Address - Fax:734-973-0595
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704091276367A00000X, 163W00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology