Provider Demographics
NPI:1679929111
Name:MARTINEZ, BRANDI ALEXANDRIA (CNP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:ALEXANDRIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:ALEXANDRIA
Other - Last Name:DEMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:2020 ANDERSON FERRY RD STE A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3371
Mailing Address - Country:US
Mailing Address - Phone:513-347-6100
Mailing Address - Fax:
Practice Address - Street 1:2020 ANDERSON FERRY RD STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3371
Practice Address - Country:US
Practice Address - Phone:513-347-6100
Practice Address - Fax:513-347-7100
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN356643363LP0808X
OHCOA.18973-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0173547Medicaid