Provider Demographics
NPI:1578044947
Name:BRAZLE, EKIKERE E
Entity type:Individual
Prefix:
First Name:EKIKERE
Middle Name:E
Last Name:BRAZLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 HAYWARDS CROSSING SOUTH CIR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2658
Mailing Address - Country:US
Mailing Address - Phone:713-530-3425
Mailing Address - Fax:
Practice Address - Street 1:4502 RIVERSTONE BLVD STE 905
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5206
Practice Address - Country:US
Practice Address - Phone:281-903-7613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211711164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse