Provider Demographics
NPI:1235734096
Name:RIORDAN, BRANDI LEE (CNA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:LEE
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MISS
Other - First Name:BRANDI
Other - Middle Name:LEE
Other - Last Name:RIORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MOMMA BEAR CAREGIVER
Mailing Address - Street 1:35928 COUNTY ROAD 39
Mailing Address - Street 2:
Mailing Address - City:STAPLETON
Mailing Address - State:AL
Mailing Address - Zip Code:36578-3022
Mailing Address - Country:US
Mailing Address - Phone:251-284-6256
Mailing Address - Fax:
Practice Address - Street 1:35928 COUNTY ROAD 39
Practice Address - Street 2:
Practice Address - City:STAPLETON
Practice Address - State:AL
Practice Address - Zip Code:36578-3022
Practice Address - Country:US
Practice Address - Phone:251-284-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRES915550374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALRES15550OtherMOMMA BEAR CAREGIVERS LLC