Provider Demographics
NPI:1871667337
Name:BRABANT, KAREN ELAINE (MS, ACNP-BC,CNS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELAINE
Last Name:BRABANT
Suffix:
Gender:F
Credentials:MS, ACNP-BC,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29832 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-7947
Mailing Address - Country:US
Mailing Address - Phone:951-442-5467
Mailing Address - Fax:
Practice Address - Street 1:29832 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7947
Practice Address - Country:US
Practice Address - Phone:951-442-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16603363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871667337Medicaid
CA1871667337Medicaid