Provider Demographics
NPI:1609910694
Name:CONNERS, BRANDY DANIELLE (LPN)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:DANIELLE
Last Name:CONNERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:49 CATHERINE ST
Mailing Address - City:PARISHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13672-0587
Mailing Address - Country:US
Mailing Address - Phone:315-265-3670
Mailing Address - Fax:
Practice Address - Street 1:737 STATE HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3411
Practice Address - Country:US
Practice Address - Phone:315-265-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277829164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02588916Medicaid