Provider Demographics
NPI:1770718173
Name:ALWINE, BRANDI LANICE (PA)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LANICE
Last Name:ALWINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LANICE
Other - Last Name:ALSPACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:416 E MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-2015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 E MAUMEE ST STE 303
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-2044
Practice Address - Country:US
Practice Address - Phone:260-667-5148
Practice Address - Fax:260-667-5689
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.005063OtherMEDICAL LICENSE