Healthcare Provider Details

I. General information

NPI: 1548357296
Provider Name (Legal Business Name): BRANDIE A NANCE AUD CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W174 GROVER CENTER
ATHENS OH
45701
US

IV. Provider business mailing address

W174 GROVER CENTER
ATHENS OH
45701
US

V. Phone/Fax

Practice location:
  • Phone: 740-589-2305
  • Fax: 740-593-4433
Mailing address:
  • Phone: 740-589-2305
  • Fax: 740-593-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA01437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: