Healthcare Provider Details

I. General information

NPI: 1558891127
Provider Name (Legal Business Name): BRANDI DORA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDI KEIZER NP-C

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HOLTON RD STE 200
MUSKEGON MI
49445-1505
US

IV. Provider business mailing address

2006 HOLTON RD STE 200
MUSKEGON MI
49445-1505
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-3333
  • Fax: 231-672-6520
Mailing address:
  • Phone: 231-672-3333
  • Fax: 231-672-6520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704281793
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: