Healthcare Provider Details

I. General information

NPI: 1609173152
Provider Name (Legal Business Name): KATRINA DAWN BRANDENBURG RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST SUITE NW3300
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST SUITE NW3300
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8394
  • Fax: 937-208-8388
Mailing address:
  • Phone: 937-208-8394
  • Fax: 937-208-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 251676
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA 12146 NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: