Provider Demographics
NPI:1114562733
Name:DAVIS, BRANDI TERDRA
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:TERDRA
Last Name:DAVIS
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 1:4736 WAKEFIELD RD APT 202
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-1085
Mailing Address - Country:US
Mailing Address - Phone:443-985-9480
Mailing Address - Fax:
Practice Address - Street 1:4736 WAKEFIELD RD APT 202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-1085
Practice Address - Country:US
Practice Address - Phone:410-979-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
MDA00172938251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care