Provider Demographics
NPI:1134172950
Name:BRANDFASS, BRANDY (RN, CPM)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:BRANDFASS
Suffix:
Gender:F
Credentials:RN, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 TRIMLEY CT
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7076
Mailing Address - Country:US
Mailing Address - Phone:843-824-6823
Mailing Address - Fax:843-824-6823
Practice Address - Street 1:106 TRIMLEY CT
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7076
Practice Address - Country:US
Practice Address - Phone:843-824-6823
Practice Address - Fax:843-824-6823
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLM-037176B00000X
SCR71962163WM0102X
SC08080001176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLM0018Medicaid