Provider Demographics
NPI:1801184106
Name:BERDOU, BRANDY LEIGH (RN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LEIGH
Last Name:BERDOU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 POPE AVE
Mailing Address - Street 2:MUNSON ARMY HEALTH CENTER (ATTN: CREDENTIALS)
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-2332
Mailing Address - Country:US
Mailing Address - Phone:913-684-6000
Mailing Address - Fax:
Practice Address - Street 1:550 POPE AVE
Practice Address - Street 2:MUNSON ARMY HEALTH CENTER (ATTN: CREDENTIALS)
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2332
Practice Address - Country:US
Practice Address - Phone:913-684-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO196012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse