Provider Demographics
NPI:1619709367
Name:KANTNER, BRANDON MICHAEL
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
Last Name:KANTNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 LAUREL RUN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-9232
Mailing Address - Country:US
Mailing Address - Phone:570-401-2711
Mailing Address - Fax:
Practice Address - Street 1:3601 LINCOLN HWY E
Practice Address - Street 2:
Practice Address - City:KINZERS
Practice Address - State:PA
Practice Address - Zip Code:17535-9616
Practice Address - Country:US
Practice Address - Phone:570-401-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031906363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty