Provider Demographics
NPI:1932568359
Name:HERBST, BRANDY (OWNER)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:HERBST
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1271
Mailing Address - Country:US
Mailing Address - Phone:763-689-8984
Mailing Address - Fax:763-689-1170
Practice Address - Street 1:626 MAIN ST N
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1271
Practice Address - Country:US
Practice Address - Phone:763-689-8984
Practice Address - Fax:763-689-1170
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-12
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26-1859564163WH0200X, 163WW0000X, 3747A0650X, 3747P1801X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker