Provider Demographics
NPI:1336987130
Name:BRASS, DOREEN E (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:E
Last Name:BRASS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8577
Mailing Address - Country:US
Mailing Address - Phone:682-200-9099
Mailing Address - Fax:
Practice Address - Street 1:2439 WALKER ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8577
Practice Address - Country:US
Practice Address - Phone:682-200-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX764390163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant