Provider Demographics
NPI:1881602514
Name:DEPALMA, BRANDI L (CNS)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:L
Last Name:DEPALMA
Suffix:
Gender:F
Credentials:CNS
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 1879
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-1879
Mailing Address - Country:US
Mailing Address - Phone:325-949-9408
Mailing Address - Fax:
Practice Address - Street 1:3016 VISTA DEL ARROYO DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6146
Practice Address - Country:US
Practice Address - Phone:325-949-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652573364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ35027Medicare UPIN
TX8G4325Medicare ID - Type UnspecifiedMEDICARE