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Organization
CENTER FOR MYOFASCIAL THERAPEUTICS AND AESTHETICS
Active
Organization
CENTER FOR MYOFASCIAL THERAPEUTICS AND AESTHETICS
Active
Other names
Brazzale Surgical Assisting LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ARIEL BRAZZALE NP (CEO)
(219) 669-1034
Entity
Organization
Contact information
Practice address
9430 WICKER AVE, SAINT JOHN, IN 46373-9400
(219) 558-8068
(877) 822-9116
Mailing address
9430 WICKER AVE, SAINT JOHN, IN 46373-9400
(219) 558-8068
(877) 822-9116
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
—
NULL
246ZC0007X
Surgical Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71013263A
INDIANA NURSING BOARD LICENSE
IN
Enumeration date
09/20/2019
Last updated
08/21/2023
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