Provider Demographics
NPI:1043562101
Name:GROW, BRANDON JOSEPH (EMT PARAMEDIC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JOSEPH
Last Name:GROW
Suffix:
Gender:M
Credentials:EMT PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OLAVARRIA
Mailing Address - Street 2:FT. MCDERMITT E.M.S.
Mailing Address - City:MCDERMITT
Mailing Address - State:NV
Mailing Address - Zip Code:89421
Mailing Address - Country:US
Mailing Address - Phone:775-532-8530
Mailing Address - Fax:775-532-8531
Practice Address - Street 1:20 OLAVARRIA
Practice Address - Street 2:FT. MCDERMITT E.M.S.
Practice Address - City:MCDERMITT
Practice Address - State:NV
Practice Address - Zip Code:89421
Practice Address - Country:US
Practice Address - Phone:775-532-8530
Practice Address - Fax:775-532-8531
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVP8055188146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic