Provider Demographics
NPI:1720441751
Name:LEVI, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:LEVI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 JESSICA CT
Mailing Address - Street 2:
Mailing Address - City:ALLENHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31301-2515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42 JESSICA CT
Practice Address - Street 2:
Practice Address - City:ALLENHURST
Practice Address - State:GA
Practice Address - Zip Code:31301-2515
Practice Address - Country:US
Practice Address - Phone:321-634-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326711164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse