Healthcare Provider Details

I. General information

NPI: 1114561297
Provider Name (Legal Business Name): BRANDIE ANNE HERDLITZKA MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 AMANDA NORTHERN RD SW
AMANDA OH
43102-9332
US

IV. Provider business mailing address

2432 PERRY RDG
NELSONVILLE OH
45764-9515
US

V. Phone/Fax

Practice location:
  • Phone: 740-969-4828
  • Fax:
Mailing address:
  • Phone: 740-590-6862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN.CNP.025898
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: