Provider Demographics
NPI:1033860101
Name:BLANCHARD, BRANDY DAWN (RN)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:DAWN
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 MARINA BAY DR SLIP 25
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-2574
Mailing Address - Country:US
Mailing Address - Phone:254-716-8005
Mailing Address - Fax:
Practice Address - Street 1:925 MARINA BAY DR SLIP 25
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-2574
Practice Address - Country:US
Practice Address - Phone:254-716-8005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX794686163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty