Provider Demographics
NPI:1982258281
Name:BENGOA, BRANDY MICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:MICHELLE
Last Name:BENGOA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:BRANDY
Other - Middle Name:MICHELLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 STATE ROUTE 305
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820
Mailing Address - Country:US
Mailing Address - Phone:775-635-2386
Mailing Address - Fax:775-635-9203
Practice Address - Street 1:825 N 2ND STREET
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820
Practice Address - Country:US
Practice Address - Phone:775-635-2386
Practice Address - Fax:775-635-9203
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN89032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse