Provider Demographics
NPI:1619006616
Name:BRANDEWIE, BRENDT ALLEN
Entity Type:Individual
Prefix:MR
First Name:BRENDT
Middle Name:ALLEN
Last Name:BRANDEWIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CGC ACTIVE
Mailing Address - Street 2:EDIZ HOOK RD
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-417-5970
Mailing Address - Fax:
Practice Address - Street 1:CGC ACTIVE
Practice Address - Street 2:EDIZ HOOK RD
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362
Practice Address - Country:US
Practice Address - Phone:360-417-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other