Provider Demographics
NPI:1487025177
Name:RICHARDS, BRANDIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:
Last Name:RICHARDS
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 1:33494 OAK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2057
Mailing Address - Country:US
Mailing Address - Phone:909-881-4335
Mailing Address - Fax:
Practice Address - Street 1:33494 OAK GLEN RD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2057
Practice Address - Country:US
Practice Address - Phone:909-881-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily