Healthcare Provider Details

I. General information

NPI: 1932568359
Provider Name (Legal Business Name): BRANDY HERBST OWNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 MAIN ST N
CAMBRIDGE MN
55008-1271
US

IV. Provider business mailing address

626 MAIN ST N
CAMBRIDGE MN
55008-1271
US

V. Phone/Fax

Practice location:
  • Phone: 763-689-8984
  • Fax: 763-689-1170
Mailing address:
  • Phone: 763-689-8984
  • Fax: 763-689-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number26-1859564
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number26-1859564
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number26-1859564
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number26-1859564
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number26-1859564
License Number StateMN
# 6
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number26-1859564
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: