Provider Demographics
NPI:1598367096
Name:BRIAN, MANDY LYNN
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNN
Last Name:BRIAN
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 1:229 EAST DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5105
Mailing Address - Country:US
Mailing Address - Phone:225-205-4062
Mailing Address - Fax:
Practice Address - Street 1:229 EAST DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5105
Practice Address - Country:US
Practice Address - Phone:225-205-4062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator