Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4431 | WI |
N | 363LA2100X | Nurse Practitioner - Acute Care | 4431-33 | WI |
NPI | 1033407010 |
---|---|
Provider Name | Kelly Rosemary Brandt |
First Address | Rhinelander, WI 54501-6710 |
Second Address | Rhinelander, WI 54501-6710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 01/04/2021 |