Provider Demographics
NPI:1720259500
Name:NISSLEY, BRANDY NICHOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:NICHOLE
Last Name:NISSLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:BRANDY
Other - Middle Name:NICHOLE
Other - Last Name:AUSTERMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:5 E WASHINGTON ST
Mailing Address - City:DANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43014-0385
Mailing Address - Country:US
Mailing Address - Phone:740-398-2520
Mailing Address - Fax:
Practice Address - Street 1:5 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43014-0385
Practice Address - Country:US
Practice Address - Phone:740-398-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN120870164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse