Provider Demographics
NPI:1902448244
Name:BRANDY, MICAELA CLISELDA
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:CLISELDA
Last Name:BRANDY
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 1:356 APOLLO AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-5951
Mailing Address - Country:US
Mailing Address - Phone:757-771-3890
Mailing Address - Fax:
Practice Address - Street 1:356 APOLLO AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-5951
Practice Address - Country:US
Practice Address - Phone:757-771-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI95475163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse