Healthcare Provider Details

I. General information

NPI: 1124313549
Provider Name (Legal Business Name): BRANDIE VALENCIA-MOORE GIRMANN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDIE VALENCIA MOORE PA-C

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 INDUSTRIAL DR
FRANKLIN OH
45005-4429
US

IV. Provider business mailing address

235 INDUSTRIAL DR
FRANKLIN OH
45005-4429
US

V. Phone/Fax

Practice location:
  • Phone: 937-743-9474
  • Fax: 937-743-9475
Mailing address:
  • Phone: 937-743-9474
  • Fax: 937-743-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.002863
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: