Healthcare Provider Details

I. General information

NPI: 1285453134
Provider Name (Legal Business Name): BRANDIE MARIE HEREDIA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 S GILBERT RD STE 1
CHANDLER AZ
85286-1590
US

IV. Provider business mailing address

3317 S HIGLEY RD STE 114-213
GILBERT AZ
85297-5436
US

V. Phone/Fax

Practice location:
  • Phone: 480-737-1394
  • Fax:
Mailing address:
  • Phone: 480-204-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN172688
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number320249
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: