Provider Demographics
NPI:1336996586
Name:ANDERSON, BRANDI
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5738 63RD ST NE
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:ND
Mailing Address - Zip Code:58346-9756
Mailing Address - Country:US
Mailing Address - Phone:701-230-8515
Mailing Address - Fax:
Practice Address - Street 1:5738 63RD ST NE
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:ND
Practice Address - Zip Code:58346-9756
Practice Address - Country:US
Practice Address - Phone:701-230-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant