Provider Demographics
NPI:1417775669
Name:VERMILLION, BRANDON (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:VERMILLION
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-4554
Mailing Address - Country:US
Mailing Address - Phone:765-278-8775
Mailing Address - Fax:
Practice Address - Street 1:2659 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-4554
Practice Address - Country:US
Practice Address - Phone:765-278-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0037600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner