Provider Demographics
NPI:1568756336
Name:BRANDON, LISA ANN
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:BRANDON
Suffix:
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 1:850 GANN RD
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38316-8727
Mailing Address - Country:US
Mailing Address - Phone:731-487-2245
Mailing Address - Fax:
Practice Address - Street 1:633 HIGH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-1703
Practice Address - Country:US
Practice Address - Phone:731-986-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000177467163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse