Provider Demographics
NPI:1225715238
Name:MARTIN, BRANDY (LPN)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:MARTIN
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 471
Mailing Address - Street 2:
Mailing Address - City:DAVIN
Mailing Address - State:WV
Mailing Address - Zip Code:25617-0471
Mailing Address - Country:US
Mailing Address - Phone:304-687-0838
Mailing Address - Fax:
Practice Address - Street 1:46 FRIENDLY NEIGHBOR DRIVE
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28840164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse