Provider Demographics
NPI:1396722591
Name:BRANDL, AMY F (CNM)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:F
Last Name:BRANDL
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:6500 EXCELSIOR BLVD
Mailing Address - Street 2:HVC- 5TH FLOOR
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4702
Mailing Address - Country:US
Mailing Address - Phone:952-993-3282
Mailing Address - Fax:952-993-1361
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:HVC- 5TH FLOOR
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4702
Practice Address - Country:US
Practice Address - Phone:952-993-3282
Practice Address - Fax:952-993-1361
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 136429-5367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN420000234Medicare ID - Type Unspecified
MN827015500Medicaid
MNS35673Medicare UPIN