Healthcare Provider Details

I. General information

NPI: 1275165318
Provider Name (Legal Business Name): BRANDY MITCHELL HANUS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SCOTT AND WHITE DR
COLLEGE STATION TX
77845-6441
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 979-207-0100
  • Fax:
Mailing address:
  • Phone: 800-994-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number781512
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP145477
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: