Provider Demographics
NPI:1578781019
Name:BRANDON, BARBARA M (LPN11(NURSE))
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:M
Last Name:BRANDON
Suffix:
Gender:F
Credentials:LPN11(NURSE)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-4653
Mailing Address - Country:US
Mailing Address - Phone:662-328-3247
Mailing Address - Fax:662-328-9854
Practice Address - Street 1:1005 4TH AVE N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-4653
Practice Address - Country:US
Practice Address - Phone:662-328-3247
Practice Address - Fax:662-328-9854
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP230987164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse