Provider Demographics
NPI:1558505131
Name:DANTZER, BRANDY M (NP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:DANTZER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:M
Other - Last Name:HITCHCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:MEDPARTNERS, ATTN: BARB COPELAND
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7900 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4128
Practice Address - Country:US
Practice Address - Phone:260-432-2297
Practice Address - Fax:260-969-7266
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002932A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061080Medicaid
IN200939130Medicaid
INM400063850Medicare PIN