Provider Demographics
NPI:1255425534
Name:BRANDMARK, ADELE COLT (CRNP)
Entity type:Individual
Prefix:
First Name:ADELE
Middle Name:COLT
Last Name:BRANDMARK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ADELE
Other - Middle Name:TERESA
Other - Last Name:COLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:337 MAPLE AVE E
Mailing Address - Street 2:MINUTE CLINIC, INSIDE CVS
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4717
Mailing Address - Country:US
Mailing Address - Phone:703-938-9490
Mailing Address - Fax:
Practice Address - Street 1:337 MAPLE AVE E
Practice Address - Street 2:MINUTE CLINIC, INSIDE CVS
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4717
Practice Address - Country:US
Practice Address - Phone:703-938-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016978M58Medicare UPIN
VA141908ZCCUMedicare PIN