Provider Demographics
NPI:1275013195
Name:LIME, BRANDON STEPHEN
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:STEPHEN
Last Name:LIME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 SW SEQUOIA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1484
Mailing Address - Country:US
Mailing Address - Phone:541-740-3140
Mailing Address - Fax:
Practice Address - Street 1:3516 NW CORONADO ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4695
Practice Address - Country:US
Practice Address - Phone:541-360-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion