Provider Demographics
NPI:1194077313
Name:BRASHER, DANA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARIE
Last Name:BRASHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5084 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-3324
Mailing Address - Country:US
Mailing Address - Phone:779-348-9388
Mailing Address - Fax:815-282-2034
Practice Address - Street 1:5084 GRANITE ST
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-3324
Practice Address - Country:US
Practice Address - Phone:779-348-9388
Practice Address - Fax:815-282-2034
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041252385163W00000X
WI15031630163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse