Provider Demographics
NPI:1770192791
Name:MARTISEK, BRANDY VANELL (NP)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:VANELL
Last Name:MARTISEK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 HIGHWAY 79 S
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-9129
Mailing Address - Country:US
Mailing Address - Phone:870-235-6001
Mailing Address - Fax:
Practice Address - Street 1:2270 HIGHWAY 79 S
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-9129
Practice Address - Country:US
Practice Address - Phone:870-235-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-26
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR125499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily