Provider Demographics
NPI:1235574922
Name:FOSTER, BRANDEE MES'SHON
Entity Type:Individual
Prefix:
First Name:BRANDEE
Middle Name:MES'SHON
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDEE
Other - Middle Name:MEE'SHON
Other - Last Name:RHONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6416 PLAYA DE CARMEN WAY
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1418
Mailing Address - Country:US
Mailing Address - Phone:702-686-6714
Mailing Address - Fax:
Practice Address - Street 1:6416 PLAYA DE CARMEN WAY
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-1418
Practice Address - Country:US
Practice Address - Phone:702-686-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker