Provider Demographics
NPI:1538310883
Name:ANDERSEN, BRANDI WIEBUSCH (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:WIEBUSCH
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 E COLFAX AVE STE 4-240
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1566
Mailing Address - Country:US
Mailing Address - Phone:303-900-2315
Mailing Address - Fax:855-595-2930
Practice Address - Street 1:6110 E COLFAX AVE STE 4-240
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1566
Practice Address - Country:US
Practice Address - Phone:303-900-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO175113163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1538804539Other193400000X