Provider Demographics
NPI:1457749459
Name:EGLAND, BRANDY
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:EGLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:MIHALAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5118 OLD ZUCK RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4916
Mailing Address - Country:US
Mailing Address - Phone:814-877-6451
Mailing Address - Fax:814-877-6297
Practice Address - Street 1:1647 SASSAFRAS ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1858
Practice Address - Country:US
Practice Address - Phone:814-877-6451
Practice Address - Fax:814-877-6297
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN273204164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse