Provider Demographics
NPI:1891295002
Name:BRICKER, BRANDI RENEE
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:RENEE
Last Name:BRICKER
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 1:18015 STATE ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:MC DERMOTT
Mailing Address - State:OH
Mailing Address - Zip Code:45652-8925
Mailing Address - Country:US
Mailing Address - Phone:740-352-5480
Mailing Address - Fax:
Practice Address - Street 1:18015 STATE ROUTE 73
Practice Address - Street 2:
Practice Address - City:MC DERMOTT
Practice Address - State:OH
Practice Address - Zip Code:45652-8925
Practice Address - Country:US
Practice Address - Phone:740-352-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH341483163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse