Provider Demographics
NPI:1962180372
Name:ALLEN, BRANDY LABRITT
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LABRITT
Last Name:ALLEN
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 1:920 W OWENS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2516
Mailing Address - Country:US
Mailing Address - Phone:702-659-6910
Mailing Address - Fax:702-659-6921
Practice Address - Street 1:920 W OWENS AVE STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2516
Practice Address - Country:US
Practice Address - Phone:702-659-6910
Practice Address - Fax:702-659-6921
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8528208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice