Provider Demographics
NPI:1457623928
Name:GERMAN, BRANDY M (NP-C)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:GERMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:RITTER
Other - Last Name:GERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:MEDPARTNERS, ATTN: MEGAN FORTNEY
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3515
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:3270 INTERTECH DR STE B
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-7325
Practice Address - Country:US
Practice Address - Phone:260-665-9100
Practice Address - Fax:260-665-9112
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003858A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201071260Medicaid
IN201071260Medicaid