Provider Demographics
NPI:1952867913
Name:BRANDENBURG, DAPHNEY ANN (BA)
Entity Type:Individual
Prefix:
First Name:DAPHNEY
Middle Name:ANN
Last Name:BRANDENBURG
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5519
Mailing Address - Country:US
Mailing Address - Phone:715-218-9480
Mailing Address - Fax:715-845-8483
Practice Address - Street 1:115 N 6TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5519
Practice Address - Country:US
Practice Address - Phone:715-218-9480
Practice Address - Fax:715-845-8483
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator