Provider Demographics
NPI:1740366723
Name:BRANDON, VALENTINA V (RN)
Entity type:Individual
Prefix:MS
First Name:VALENTINA
Middle Name:V
Last Name:BRANDON
Suffix:
Gender:F
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:PO BOX 1216
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-1216
Mailing Address - Country:US
Mailing Address - Phone:928-729-8468
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF RT N12 N7
Practice Address - Street 2:FORT DEFIANCE PHS HOSPITAL
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ059141Medicaid