Provider Demographics
NPI:1770718173
Name:ALWINE, BRANDI LANICE (PA)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:LANICE
Last Name:ALWINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LANICE
Other - Last Name:ALSPACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 FOX RD STE 105
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2490
Practice Address - Country:US
Practice Address - Phone:419-232-6051
Practice Address - Fax:419-232-6052
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.005063OtherMEDICAL LICENSE