Provider Demographics
NPI:1073094132
Name:NUGENT, BRANDY DONIELLE (LVN)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:DONIELLE
Last Name:NUGENT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 N THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-1956
Mailing Address - Country:US
Mailing Address - Phone:936-340-8966
Mailing Address - Fax:
Practice Address - Street 1:1207 N THOMPSON ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1956
Practice Address - Country:US
Practice Address - Phone:936-340-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201932164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse