Provider Demographics
NPI:1841866621
Name:BRANDT, LAURA M (LPN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 GREEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3215
Mailing Address - Country:US
Mailing Address - Phone:419-810-2433
Mailing Address - Fax:
Practice Address - Street 1:1761 GREEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3215
Practice Address - Country:US
Practice Address - Phone:419-810-2433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.177224.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse