Provider Demographics
NPI:1336495308
Name:MANSFIELD, BRANDY M (CNP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:M
Other - Last Name:KNIERIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3975 EMBASSY PKWY
Mailing Address - Street 2:STE 102
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-8320
Mailing Address - Country:US
Mailing Address - Phone:330-668-4040
Mailing Address - Fax:330-668-4078
Practice Address - Street 1:3975 EMBASSY PKWY
Practice Address - Street 2:STE 102
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8320
Practice Address - Country:US
Practice Address - Phone:330-668-4040
Practice Address - Fax:330-668-4078
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.13579363L00000X
OHCOA 13579-NP164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
12419262OtherCAQH
OH0069957Medicaid
OHH158053Medicare PIN
OH0069957Medicaid