Provider Demographics
NPI:1891361952
Name:BICKFORD, BRANDON R (RN)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:R
Last Name:BICKFORD
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-0850
Mailing Address - Country:US
Mailing Address - Phone:406-338-7912
Mailing Address - Fax:
Practice Address - Street 1:504 POPIMI ST
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417-5315
Practice Address - Country:US
Practice Address - Phone:406-338-7912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNURRNLIC160874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTNUR-RN-LIC-160874Medicaid