Provider Demographics
NPI:1477792497
Name:BRANDT, DIANE MARIE I
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:BRANDT
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 19TH ST NW STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2949
Mailing Address - Country:US
Mailing Address - Phone:507-280-0300
Mailing Address - Fax:507-536-2784
Practice Address - Street 1:3270 19TH ST NW STE 101
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2949
Practice Address - Country:US
Practice Address - Phone:507-280-0300
Practice Address - Fax:507-536-2784
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-14
Last Update Date:2009-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor