Provider Demographics
NPI:1851154801
Name:MADDOX, BRANDON ANDREW (RN)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:ANDREW
Last Name:MADDOX
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 PORTWEST TER
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-5564
Mailing Address - Country:US
Mailing Address - Phone:804-543-3856
Mailing Address - Fax:
Practice Address - Street 1:413 PORTWEST TER
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-5564
Practice Address - Country:US
Practice Address - Phone:804-543-3856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001232582163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice