Provider Demographics
NPI:1588210330
Name:CANTRELL, BRANDI (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:M
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:7650 E PARHAM RD STE 110
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4376
Practice Address - Country:US
Practice Address - Phone:804-916-7062
Practice Address - Fax:804-918-2172
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177836207N00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024177836OtherLICENSE TO PRACTICE AS A NURSE PRACTITONER