Healthcare Provider Details

I. General information

NPI: 1861908113
Provider Name (Legal Business Name): BRANDI NICHOLE RULLAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRANDI N MANTHEI CRNA

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 W FARMINGTON RD
VAN ALSTYNE TX
75495-2274
US

IV. Provider business mailing address

1263 W FARMINGTON RD
VAN ALSTYNE TX
75495-2274
US

V. Phone/Fax

Practice location:
  • Phone: 214-232-9391
  • Fax:
Mailing address:
  • Phone: 214-232-9391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number818199
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number818199
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9394356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: