Provider Demographics
NPI:1346950623
Name:MANNI, BRANDIE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:MARIE
Last Name:MANNI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:MARIE
Other - Last Name:WINDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:13108 WOODRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3891
Mailing Address - Country:US
Mailing Address - Phone:810-844-6056
Mailing Address - Fax:
Practice Address - Street 1:7804 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1702
Practice Address - Country:US
Practice Address - Phone:313-562-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant