Healthcare Provider Details

I. General information

NPI: 1396017364
Provider Name (Legal Business Name): BRANDY NOAKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDY FERRARA IDMT

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 10/01/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72ND AMDS/SGPF 7050 AIR DEPOT BLVD, BLDG 1094
TINKER AFB OK
73145-8102
US

IV. Provider business mailing address

23641 PLEASANT HILL RD
BURNT CABINS PA
17215-9437
US

V. Phone/Fax

Practice location:
  • Phone: 405-734-6626
  • Fax:
Mailing address:
  • Phone: 717-816-5730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: