Provider Demographics
NPI:1578280780
Name:BRANDT, DIANE SUE (RN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:SUE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-5903
Mailing Address - Country:US
Mailing Address - Phone:419-213-7614
Mailing Address - Fax:
Practice Address - Street 1:1200 S DETROIT AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5903
Practice Address - Country:US
Practice Address - Phone:419-213-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRN215554163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse