Provider Demographics
NPI:1912621616
Name:BRANDENBURG, JESSICA RENEE (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:BRANDENBURG
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:PREMIER ENT ASSOCIATES
Mailing Address - Street 2:30 E APPLE ST., STE 6252
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:937-208-6730
Mailing Address - Fax:937-641-7410
Practice Address - Street 1:PREMIER ENT ASSOCIATES
Practice Address - Street 2:30 E APPLE ST., STE 6252
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-6730
Practice Address - Fax:937-641-7410
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP.0032267363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner