Provider Demographics
NPI:1386913176
Name:BRANDT-CALDERON, VIRGINIA ALICE (RN)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ALICE
Last Name:BRANDT-CALDERON
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 1:3010 LAFAYETTE RD
Mailing Address - Street 2:LAFAYETTE
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-3411
Mailing Address - Country:US
Mailing Address - Phone:315-677-6917
Mailing Address - Fax:
Practice Address - Street 1:3010 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084-3411
Practice Address - Country:US
Practice Address - Phone:315-677-6917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY459571-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse