Provider Demographics
NPI:1669680930
Name:BRANDTS, NICHOLE LEE (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LEE
Last Name:BRANDTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6292 OLD US HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-8716
Mailing Address - Country:US
Mailing Address - Phone:937-378-1378
Mailing Address - Fax:
Practice Address - Street 1:820 DELTA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-1221
Practice Address - Country:US
Practice Address - Phone:513-321-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0741622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2239849Medicaid
OHBR7320351Medicare ID - Type Unspecified
OH2239849Medicaid