Provider Demographics
NPI:1295798734
Name:SPEERSTRA, BRANDY (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:SPEERSTRA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-2130
Mailing Address - Country:US
Mailing Address - Phone:814-676-7600
Mailing Address - Fax:814-676-7975
Practice Address - Street 1:100 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2130
Practice Address - Country:US
Practice Address - Phone:814-676-7600
Practice Address - Fax:814-676-7975
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q56955Medicare UPIN
Q56955Medicare UPIN