Provider Demographics
NPI:1548357296
Name:NANCE, BRANDIE A (AUD CCCA)
Entity type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:A
Last Name:NANCE
Suffix:
Gender:F
Credentials:AUD CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W174 GROVER CENTER
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-589-2305
Mailing Address - Fax:740-593-4433
Practice Address - Street 1:W174 GROVER CENTER
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-589-2305
Practice Address - Fax:740-593-4433
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01437231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000486914OtherANTHEM
OH4115912Medicare PIN