Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 08080001 | SC |
N | 176B00000X | Midwife | LM-037 | SC |
NPI | 1134172950 |
---|---|
Provider Name | Brandy Brandfass |
First Address | Goose Creek, SC 29445-7076 |
Second Address | Goose Creek, SC 29445-7076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 14/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LM0018 | (05) | SC |