Provider Demographics
NPI:1265759195
Name:CRAFT, BRANDI L (LPN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:L
Last Name:CRAFT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CALDWELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:NY
Mailing Address - Zip Code:13797-2109
Mailing Address - Country:US
Mailing Address - Phone:607-205-0716
Mailing Address - Fax:
Practice Address - Street 1:140 CALDWELL HILL RD
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:NY
Practice Address - Zip Code:13797-2109
Practice Address - Country:US
Practice Address - Phone:607-205-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10295494164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse