Provider Demographics
NPI:1578064143
Name:MARTIN, BRANDI RENEE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:RENEE
Last Name:MARTIN
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 1:101 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-2016
Mailing Address - Country:US
Mailing Address - Phone:972-213-2377
Mailing Address - Fax:
Practice Address - Street 1:101 STANLEY ST
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452-2016
Practice Address - Country:US
Practice Address - Phone:972-213-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX879387163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse