Provider Demographics
NPI:1255800645
Name:BRAZILE, LAQUITA SHENAY (LM)
Entity type:Individual
Prefix:MS
First Name:LAQUITA
Middle Name:SHENAY
Last Name:BRAZILE
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 LYNNETTE CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134
Mailing Address - Country:US
Mailing Address - Phone:469-744-6943
Mailing Address - Fax:
Practice Address - Street 1:1726 CHADWICK CT
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054
Practice Address - Country:US
Practice Address - Phone:817-280-9962
Practice Address - Fax:817-479-0124
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99357176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife