Provider Demographics
NPI:1568261469
Name:BRANDON, MARIAH D (LPN)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:D
Last Name:BRANDON
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4443 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1123
Mailing Address - Country:US
Mailing Address - Phone:810-733-1185
Mailing Address - Fax:810-600-3395
Practice Address - Street 1:4443 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1123
Practice Address - Country:US
Practice Address - Phone:810-733-1185
Practice Address - Fax:810-600-3395
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703129561164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse