Basic Information
| Provider Information | |||||||||
| NPI: | 1679680474 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAZILE | ||||||||
| FirstName: | CATHLEEN | ||||||||
| MiddleName: | O'NEAL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN, FNP, BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BRAZILE | ||||||||
| OtherFirstName: | LINDA | ||||||||
| OtherMiddleName: | CATHLEEN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN, FNP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4 CLEMENT WAY | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049174370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074953323 | ||||||||
| FaxNumber: | 2074953353 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 CLEMENT WAY | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049174370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074953323 | ||||||||
| FaxNumber: | 2074953353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 01/23/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CNP161185 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 00193081 | 01 | TX | DPS | OTHER | 6849190161 | 01 | DOT MEDICAL EXAMINER NUMBER | OTHER | F0406060 | 01 | AMERICAN ACADEMY OF N P'S | OTHER | MB1504946 | 01 | TX | DEA | OTHER | TX114678 | 01 | TEXAS APRN NUMBER | OTHER | 649921 | 01 | TX | BOARD OF NURSING | OTHER | 6770-33 | 01 | WI | WISCONSIN APRN LICENSE | OTHER | APN RX | 01 | TX | 5563 | OTHER |