Provider Demographics
NPI:1144548116
Name:RAND, BRANDI AMBER (APRN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:AMBER
Last Name:RAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CENTER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4046
Mailing Address - Country:US
Mailing Address - Phone:802-772-7136
Mailing Address - Fax:866-271-4702
Practice Address - Street 1:73 CENTER ST STE 2
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4046
Practice Address - Country:US
Practice Address - Phone:802-772-7136
Practice Address - Fax:866-271-4702
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0082934363LP0808X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020184Medicaid
NY04176514Medicaid
NY04176514Medicaid