Provider Demographics
NPI:1275374449
Name:BRANDT, JANELLE D
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:D
Last Name:BRANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 STONEY OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:CA
Mailing Address - Zip Code:95914-9716
Mailing Address - Country:US
Mailing Address - Phone:530-884-4131
Mailing Address - Fax:
Practice Address - Street 1:51 STONEY OAKS BLVD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:CA
Practice Address - Zip Code:95914-9716
Practice Address - Country:US
Practice Address - Phone:530-884-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN154576164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse