Provider Demographics
NPI:1407654379
Name:LOVE, BRANDY NICOLE (NBCR)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:NICOLE
Last Name:LOVE
Suffix:
Gender:F
Credentials:NBCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 S BELL BLVD STE 301D
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3975
Mailing Address - Country:US
Mailing Address - Phone:409-594-2735
Mailing Address - Fax:
Practice Address - Street 1:930 S BELL BLVD STE 301D
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3975
Practice Address - Country:US
Practice Address - Phone:409-594-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
B01956173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist