Provider Demographics
NPI:1184865602
Name:MILES, BRANDY C (LMP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:C
Last Name:MILES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NW 12TH AVE
Mailing Address - Street 2:STE. 125
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9141
Mailing Address - Country:US
Mailing Address - Phone:360-687-6307
Mailing Address - Fax:360-687-6309
Practice Address - Street 1:101 NW 12TH AVE
Practice Address - Street 2:STE. 125
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9141
Practice Address - Country:US
Practice Address - Phone:360-687-6307
Practice Address - Fax:360-687-6309
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist