Provider Demographics
NPI:1720152937
Name:BRABANDT, ERIN RUTH (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:RUTH
Last Name:BRABANDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRABANDT
Other - Middle Name:RUTH
Other - Last Name:ERIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1024 30TH AVE LANE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601
Mailing Address - Country:US
Mailing Address - Phone:720-989-4565
Mailing Address - Fax:
Practice Address - Street 1:1105 FAIRGROVE CHURCH RD SE
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9090
Practice Address - Country:US
Practice Address - Phone:828-267-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102916363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC102916OtherLICENSURE
CO1623OtherSTATES LICENSE NUMBER