Provider Demographics
NPI:1295244382
Name:CANTERBURY, BRANDI NICOLE (RN,BSN)
Entity type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:NICOLE
Last Name:CANTERBURY
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WILDCAT WAY
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3474
Mailing Address - Country:US
Mailing Address - Phone:304-752-1804
Mailing Address - Fax:304-752-0207
Practice Address - Street 1:14 WILDCAT WAY
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3474
Practice Address - Country:US
Practice Address - Phone:304-752-1804
Practice Address - Fax:304-752-0207
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61987163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool