Provider Demographics
NPI:1124257696
Name:BRANDY, JULIE MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MARIE
Last Name:BRANDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 MILLER DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-8091
Mailing Address - Country:US
Mailing Address - Phone:574-941-1000
Mailing Address - Fax:574-941-1075
Practice Address - Street 1:2855 MILLER DR
Practice Address - Street 2:SUITE 119
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-8091
Practice Address - Country:US
Practice Address - Phone:574-941-1000
Practice Address - Fax:574-941-1075
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily