Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 55864 | MN |
NPI | 1013146737 |
---|---|
Provider Name | Stacy Lynette Brazier |
First Address | Brainerd, MN 56401-3054 |
Second Address | Brainerd, MN 56401-3054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2009 |
Last Update Date | 13/01/2016 |