Provider Demographics
NPI:1760916977
Name:WOOD, BRANDIE LEA
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:LEA
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:LEA
Other - Last Name:BETTINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:219 7TH ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3537
Mailing Address - Country:US
Mailing Address - Phone:307-789-0955
Mailing Address - Fax:307-789-1902
Practice Address - Street 1:219 7TH ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3537
Practice Address - Country:US
Practice Address - Phone:307-789-0955
Practice Address - Fax:307-789-1902
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator