Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 01040814A | IN |
NPI | 1043210438 |
---|---|
Provider Name | Mrs. Carla Maria Brandt |
First Address | Evansville, IN 47714-8007 |
Second Address | Evansville, IN 47714-8007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 24/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100329890A | (05) | IN |
F20899 | (02) |