Provider Demographics
NPI:1932643897
Name:JANKA, BRANDI (BSN RN)
Entity Type:Individual
Prefix:MISS
First Name:BRANDI
Middle Name:
Last Name:JANKA
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:MISS
Other - First Name:BRANDI
Other - Middle Name:
Other - Last Name:JANKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN RN
Mailing Address - Street 1:2627 E BELTLINE AVE SE STE 210
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5937
Mailing Address - Country:US
Mailing Address - Phone:616-285-5100
Mailing Address - Fax:866-941-7479
Practice Address - Street 1:2627 E BELTLINE AVE SE STE 210
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5937
Practice Address - Country:US
Practice Address - Phone:616-285-5100
Practice Address - Fax:866-941-7479
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246054146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant