Provider Demographics
NPI:1073398632
Name:NOLDER, BRANDY LEE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LEE
Last Name:NOLDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:NEW MANCHESTER
Mailing Address - State:WV
Mailing Address - Zip Code:26056-0013
Mailing Address - Country:US
Mailing Address - Phone:304-914-9778
Mailing Address - Fax:
Practice Address - Street 1:23 LOGAN CT.
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047
Practice Address - Country:US
Practice Address - Phone:304-914-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1356607394Medicaid
WV1821206228Medicaid
WV125553494Medicaid