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General NPI Number Information
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NPI Number | 1013772342
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Entity Type | Individual
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Provider Name | MADELYN BRYAN BRANDL PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 1825 N 18TH ST
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City | MONROE
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State | LA
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Zip | 71201-4420
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Country | US
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Telephone | 318-322-7999
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Fax | 318-737-7471
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Provider Business Mailing Address
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Address Line | PO BOX 792
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City | BASTROP
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State | LA
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Zip | 71221-0792
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Country | US
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Telephone | 318-283-8887
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 202759
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License Number State | LA
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