Provider Demographics
NPI:1477115178
Name:BRANDELL, TROY JOHN (COMMUNITY HEALTH AID)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:JOHN
Last Name:BRANDELL
Suffix:
Gender:M
Credentials:COMMUNITY HEALTH AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:SAND POINT
Mailing Address - State:AK
Mailing Address - Zip Code:99661-0172
Mailing Address - Country:US
Mailing Address - Phone:907-383-3151
Mailing Address - Fax:907-383-5688
Practice Address - Street 1:172 RED COVE
Practice Address - Street 2:
Practice Address - City:SAND POINT
Practice Address - State:AK
Practice Address - Zip Code:99661
Practice Address - Country:US
Practice Address - Phone:907-383-3151
Practice Address - Fax:907-383-5688
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker