Provider Demographics
NPI:1467260380
Name:BRANDON, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRANDON
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 1:314 CORNHUSKER AVE
Mailing Address - Street 2:
Mailing Address - City:ANSELMO
Mailing Address - State:NE
Mailing Address - Zip Code:68813-6904
Mailing Address - Country:US
Mailing Address - Phone:308-880-0687
Mailing Address - Fax:
Practice Address - Street 1:202 S ELMIRA ST
Practice Address - Street 2:
Practice Address - City:ANSELMO
Practice Address - State:NE
Practice Address - Zip Code:68813-7072
Practice Address - Country:US
Practice Address - Phone:308-880-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider