Provider Demographics
NPI:1114561297
Name:HERDLITZKA, BRANDIE ANNE (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:ANNE
Last Name:HERDLITZKA
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 PERRY RDG
Mailing Address - Street 2:
Mailing Address - City:NELSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45764-9515
Mailing Address - Country:US
Mailing Address - Phone:740-590-6862
Mailing Address - Fax:
Practice Address - Street 1:5115 AMANDA NORTHERN RD SW
Practice Address - Street 2:
Practice Address - City:AMANDA
Practice Address - State:OH
Practice Address - Zip Code:43102-9332
Practice Address - Country:US
Practice Address - Phone:740-969-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine