Provider Demographics
NPI:1770133563
Name:BRANTLEY, LETISHA
Entity type:Individual
Prefix:
First Name:LETISHA
Middle Name:
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-5523
Mailing Address - Country:US
Mailing Address - Phone:205-499-8739
Mailing Address - Fax:
Practice Address - Street 1:211 WILLOW ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470-5523
Practice Address - Country:US
Practice Address - Phone:205-499-8739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider