Provider Demographics
NPI:1992552376
Name:JIMENEZ, BRANDI ROSE
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:ROSE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:ROSE
Other - Last Name:ARNDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1009 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3918
Mailing Address - Country:US
Mailing Address - Phone:701-425-8878
Mailing Address - Fax:
Practice Address - Street 1:309 N MANDAN ST STE 1
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3886
Practice Address - Country:US
Practice Address - Phone:701-323-0924
Practice Address - Fax:701-323-0935
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND60941041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical