Basic Information
Provider Information
NPI: 1174948814
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRAUNSCHEIDEL
FirstName: DENISE
MiddleName: BRZEZICKI
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 908 NIAGARA FALLS BLVD
Address2: SUITE 208
City: NORTH TONAWANDA
State: NY
PostalCode: 141202019
CountryCode: US
TelephoneNumber: 7166923302
FaxNumber:  
Practice Location
Address1: 462 GRIDER ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142153021
CountryCode: US
TelephoneNumber: 7168983000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/04/2014
LastUpdateDate: 03/04/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X300955NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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