Provider Demographics
NPI:1720336118
Name:BRAZELL, BRANDICE MARIE (PA)
Entity type:Individual
Prefix:
First Name:BRANDICE
Middle Name:MARIE
Last Name:BRAZELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674
Mailing Address - Country:US
Mailing Address - Phone:630-547-5040
Mailing Address - Fax:
Practice Address - Street 1:5301 KEYSTONE CT
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3811
Practice Address - Country:US
Practice Address - Phone:847-392-5440
Practice Address - Fax:847-385-0294
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004405363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant