Provider Demographics
NPI:1932555273
Name:DILKS, BRANDI L (RRA,RT(R)(CT)(MR)
Entity Type:Individual
Prefix:MISS
First Name:BRANDI
Middle Name:L
Last Name:DILKS
Suffix:
Gender:F
Credentials:RRA,RT(R)(CT)(MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BRUCE CT
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6259
Mailing Address - Country:US
Mailing Address - Phone:302-220-8682
Mailing Address - Fax:
Practice Address - Street 1:211 BRUCE CT
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6259
Practice Address - Country:US
Practice Address - Phone:302-220-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRA72363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant