Provider Demographics
NPI:1659097095
Name:HIGHTOWER, BRANDYWINE N (IDHS)
Entity Type:Individual
Prefix:
First Name:BRANDYWINE
Middle Name:N
Last Name:HIGHTOWER
Suffix:
Gender:F
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHINCOTEAGUE
Mailing Address - State:VA
Mailing Address - Zip Code:23336-1857
Mailing Address - Country:US
Mailing Address - Phone:757-336-2844
Mailing Address - Fax:757-336-2811
Practice Address - Street 1:3823 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHINCOTEAGUE
Practice Address - State:VA
Practice Address - Zip Code:23336-1857
Practice Address - Country:US
Practice Address - Phone:757-336-2844
Practice Address - Fax:757-336-2811
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians