Provider Demographics
NPI:1366900623
Name:CANTU, BRITTANY ANN
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ANN
Last Name:CANTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-4549
Mailing Address - Country:US
Mailing Address - Phone:940-261-0111
Mailing Address - Fax:
Practice Address - Street 1:2731 TEXAS ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4549
Practice Address - Country:US
Practice Address - Phone:940-261-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317507164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse