Provider Demographics
NPI:1669274072
Name:DIAZ, BRANDI DANETA (RN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:DANETA
Last Name:DIAZ
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1021
Mailing Address - Country:US
Mailing Address - Phone:509-987-2481
Mailing Address - Fax:
Practice Address - Street 1:3231 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2121
Practice Address - Country:US
Practice Address - Phone:509-396-7189
Practice Address - Fax:509-987-1248
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60359572163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse