Provider Demographics
NPI:1588251359
Name:CASTRO, BRANDY NICOLE (RN)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:NICOLE
Last Name:CASTRO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 E CROAK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-8152
Mailing Address - Country:US
Mailing Address - Phone:570-660-0196
Mailing Address - Fax:
Practice Address - Street 1:903 E CROAK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-8152
Practice Address - Country:US
Practice Address - Phone:570-660-0196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT176492163W00000X
PARN705219163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse