Basic Information
| Provider Information | |||||||||
| NPI: | 1346354818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAZELL | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5219 CITY BANK PKWY STE 35 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067610333 | ||||||||
| FaxNumber: | 8067820097 | ||||||||
| Practice Location | |||||||||
| Address1: | 113 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | IDALOU | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068922537 | ||||||||
| FaxNumber: | 8068922726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 551054 | TX | N | Nursing Service Providers | Registered Nurse | 363LF0000X | AP110366 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 018953203 | 05 | TX | MEDICAID | 131550102 | 01 | TX | FIRST CARE | OTHER | 8N7014 | 01 | TX | BLUE CROSS | OTHER |