Provider Demographics
NPI:1699280925
Name:BRANDT, PAULA KAYE (CERTIFIED NURSE MIDW)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:KAYE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:CERTIFIED NURSE MIDW
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 1430
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-9230
Mailing Address - Country:US
Mailing Address - Phone:219-763-8112
Mailing Address - Fax:219-962-5053
Practice Address - Street 1:2490 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAKE STATION
Practice Address - State:IN
Practice Address - Zip Code:46405-2122
Practice Address - Country:US
Practice Address - Phone:219-763-8112
Practice Address - Fax:219-962-5053
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020203367A00000X
IN71007695A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife