Provider Demographics
NPI:1346483500
Name:WILLIAMS, BRANDY R (IDMT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9303 GILCREASE AVE
Mailing Address - Street 2:UNIT 1207
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0199
Mailing Address - Country:US
Mailing Address - Phone:702-408-8360
Mailing Address - Fax:
Practice Address - Street 1:9303 GILCREASE AVE
Practice Address - Street 2:UNIT 1207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0199
Practice Address - Country:US
Practice Address - Phone:702-404-1142
Practice Address - Fax:702-404-0425
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians