Provider Demographics
NPI:1407865058
Name:BRAND, IRMA ALICIA (NP)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:ALICIA
Last Name:BRAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 MACON CRK
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3682
Mailing Address - Country:US
Mailing Address - Phone:361-652-7178
Mailing Address - Fax:
Practice Address - Street 1:506 E SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6060
Practice Address - Country:US
Practice Address - Phone:361-788-6113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX594567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX594567OtherNURSE PRACTITIONERS