Provider Demographics
NPI:1063412419
Name:BRANDENBERGER, DEBRA K (NP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:BRANDENBERGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2518 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1675
Mailing Address - Country:US
Mailing Address - Phone:260-432-4400
Mailing Address - Fax:260-969-6833
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1402
Practice Address - Country:US
Practice Address - Phone:260-424-9000
Practice Address - Fax:260-425-3029
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71000773A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200262070Medicaid
IN200262070Medicaid
ININ1205002Medicare PIN
INP26694Medicare UPIN
IN204200BMedicare PIN