Provider Demographics
NPI:1427638055
Name:WAUGH, BRANDI
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:WAUGH
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:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:CHARLTON HEIGHTS
Mailing Address - State:WV
Mailing Address - Zip Code:25040-0071
Mailing Address - Country:US
Mailing Address - Phone:681-249-9500
Mailing Address - Fax:
Practice Address - Street 1:125 IMBODEN STREET
Practice Address - Street 2:
Practice Address - City:GAULEY BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:25085
Practice Address - Country:US
Practice Address - Phone:681-249-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker