Provider Demographics
NPI:1396455564
Name:BRANTUO, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BRANTUO
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 1:2076 DOWNSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5311
Mailing Address - Country:US
Mailing Address - Phone:202-940-3601
Mailing Address - Fax:
Practice Address - Street 1:2076 DOWNSHIRET
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5311
Practice Address - Country:US
Practice Address - Phone:202-940-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000803747376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide