Provider Demographics
NPI:1487875688
Name:BRANDUM, PATRICIA ANNE (RN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:BRANDUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 ESCARPMENT DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-2022
Mailing Address - Country:US
Mailing Address - Phone:440-465-0332
Mailing Address - Fax:
Practice Address - Street 1:924 ESCARPMENT DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-2022
Practice Address - Country:US
Practice Address - Phone:440-465-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-241636163W00000X
NY467912-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2221143Medicaid