Provider Demographics
NPI:1285453134
Name:HEREDIA, BRANDIE MARIE (RN)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:MARIE
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 S HIGLEY RD STE 114-213
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5436
Mailing Address - Country:US
Mailing Address - Phone:480-204-1924
Mailing Address - Fax:
Practice Address - Street 1:2410 S GILBERT RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-1590
Practice Address - Country:US
Practice Address - Phone:480-737-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN172688163WA2000X
AZ320249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator