Provider Demographics
NPI:1366254641
Name:MINNICH, BRANDY MARIE
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:MARIE
Last Name:MINNICH
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 1:503 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43532-9351
Mailing Address - Country:US
Mailing Address - Phone:419-601-3693
Mailing Address - Fax:
Practice Address - Street 1:503 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:LIBERTY CENTER
Practice Address - State:OH
Practice Address - Zip Code:43532-9351
Practice Address - Country:US
Practice Address - Phone:419-601-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker