Provider Demographics
NPI:1215519632
Name:SPENCER, BRANDI G (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:G
Last Name:SPENCER
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:G
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED HAIR LOSS
Mailing Address - Street 1:5401 S EAST ST STE 107
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2076
Mailing Address - Country:US
Mailing Address - Phone:463-224-7952
Mailing Address - Fax:
Practice Address - Street 1:5401 S EAST ST STE 107
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2076
Practice Address - Country:US
Practice Address - Phone:463-224-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBC213006171744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management