Provider Demographics
NPI:1306165683
Name:DRAZNIN, NANCY JILL (LM)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JILL
Last Name:DRAZNIN
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 1:508 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:GENESEE
Mailing Address - State:ID
Mailing Address - Zip Code:83832-9542
Mailing Address - Country:US
Mailing Address - Phone:208-310-3252
Mailing Address - Fax:
Practice Address - Street 1:508 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GENESEE
Practice Address - State:ID
Practice Address - Zip Code:83832-9542
Practice Address - Country:US
Practice Address - Phone:208-310-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-15176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife