Provider Demographics
NPI:1225262058
Name:BRANDON, PATTIE S (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PATTIE
Middle Name:S
Last Name:BRANDON
Suffix:
Gender:F
Credentials:LPN
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 240471
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-3162
Mailing Address - Country:US
Mailing Address - Phone:414-699-3937
Mailing Address - Fax:
Practice Address - Street 1:7938 NORTH 107TH STREET
Practice Address - Street 2:APT 3
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3162
Practice Address - Country:US
Practice Address - Phone:414-699-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29959164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse