Provider Demographics
NPI:1376164913
Name:MARTINEZ, BRANDY CORRINE (BAA)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:CORRINE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BAA
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:CORRINE
Other - Last Name:BELLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BAA
Mailing Address - Street 1:611 S WINN RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9647
Mailing Address - Country:US
Mailing Address - Phone:989-330-4005
Mailing Address - Fax:
Practice Address - Street 1:301 S CRAPO ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2941
Practice Address - Country:US
Practice Address - Phone:989-772-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator