1437137023 NPI number — MRS. DEBRA A. BRASIER RPH

Table of content: JACQUELINE FAITH CONWAY (NPI 1124736194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437137023 NPI number — MRS. DEBRA A. BRASIER RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRASIER
Provider First Name:
DEBRA
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437137023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28988 W KRISTY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60013-9720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-516-2836
Provider Business Mailing Address Fax Number:
815-759-4746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 W MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
CENTEGRA ANTICOAGULATION MANAGEMENT SERVICE
Provider Business Practice Location Address City Name:
MCHENRY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60050-8409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-759-4744
Provider Business Practice Location Address Fax Number:
815-759-4746
Provider Enumeration Date:
01/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)