Provider Demographics
NPI:1932603628
Name:BRACE, ALEXANDRA (CPM, LM)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:BRACE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14608 RHONE DR BLDG 2
Mailing Address - Street 2:
Mailing Address - City:DEL VALLE
Mailing Address - State:TX
Mailing Address - Zip Code:78617-5259
Mailing Address - Country:US
Mailing Address - Phone:512-827-6974
Mailing Address - Fax:
Practice Address - Street 1:14608 RHONE DR BLDG 2
Practice Address - Street 2:
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617-5259
Practice Address - Country:US
Practice Address - Phone:512-827-6974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10074256-3400176B00000X
TX99321176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife