Healthcare Provider Details

I. General information

NPI: 1285241687
Provider Name (Legal Business Name): BRANDI NICHOLE VANOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 INTERSTATE HIGHWAY
HANOVER WV
24839
US

IV. Provider business mailing address

PO BOX 647
HANOVER WV
24839-0647
US

V. Phone/Fax

Practice location:
  • Phone: 304-664-3754
  • Fax:
Mailing address:
  • Phone: 304-664-3754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: