Provider Demographics
NPI:1861908113
Name:MANTHEI, BRANDI NICHOLE (CRNA)
Entity type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:NICHOLE
Last Name:MANTHEI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAPPY TRAILS CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-4844
Mailing Address - Country:US
Mailing Address - Phone:214-232-9391
Mailing Address - Fax:
Practice Address - Street 1:200 HAPPY TRAILS CT
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-4844
Practice Address - Country:US
Practice Address - Phone:214-232-9391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-22
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX818199163W00000X, 367500000X
FLRN9394356163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse