Provider Demographics
NPI:1104162809
Name:BRANDT, CINDY ANN (RN)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:ANN
Last Name:BRANDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:ANN
Other - Last Name:HILDEBRANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:N4207 TEMKIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-8969
Mailing Address - Country:US
Mailing Address - Phone:920-296-4774
Mailing Address - Fax:
Practice Address - Street 1:N4207 TEMKIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-8969
Practice Address - Country:US
Practice Address - Phone:920-296-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9602630163W00000X
WI96026163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse