Provider Demographics
NPI:1962600981
Name:BRANTLEY, MARIE A (RNCS)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:A
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 GATEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1509
Mailing Address - Country:US
Mailing Address - Phone:301-445-1113
Mailing Address - Fax:
Practice Address - Street 1:14435 CHERRY LANE CT
Practice Address - Street 2:SUITE 206
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4959
Practice Address - Country:US
Practice Address - Phone:301-362-0090
Practice Address - Fax:301-362-0092
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO78140163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health