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
—
—
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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