Provider Demographics
NPI:1114532785
Name:DALTON, BRANDI MARIE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:MARIE
Last Name:DALTON
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 1:2213 SPUNK RUN RD
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9085
Mailing Address - Country:US
Mailing Address - Phone:740-821-6332
Mailing Address - Fax:740-493-8627
Practice Address - Street 1:2213 SPUNK RUN RD
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9085
Practice Address - Country:US
Practice Address - Phone:740-821-6332
Practice Address - Fax:740-493-8627
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist