Provider Demographics
NPI:1063897585
Name:MACDONALD, BRANDY DIANE (NP-C)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:DIANE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-2300
Mailing Address - Country:US
Mailing Address - Phone:864-834-7269
Mailing Address - Fax:
Practice Address - Street 1:2 ROPER CORNERS CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4833
Practice Address - Country:US
Practice Address - Phone:864-234-7815
Practice Address - Fax:864-234-7846
Is Sole Proprietor?:No
Enumeration Date:2015-07-26
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily