1033977756 NPI number — BRANDI WYNNE MS, CNS, LDN, CPT

NPI Number: 1033977756
Health Care Provider/Practitioner: BRANDI WYNNE MS, CNS, LDN, CPT

NPI Number : 1033977756 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033977756",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WYNNE",
    "FirstName": "BRANDI",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, CNS, LDN, CPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "100 MIDDLETOWN PARKWARY",
    "SecondLineMailingAddress": "UNIT 202",
    "MailingAddressCityName": "MIDDLETOWN",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21769-7904",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "301-276-0413",
    "MailingAddressFaxNumber": "240-771-0715",
    "FirstLinePracticeLocationAddress": "53 E PATRICK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FREDERICK",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21701-5673",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "301-276-0413",
    "PracticeLocationAddressFaxNumber": "240-771-0715",
    "EnumerationDate": "03/07/2024",
    "LastUpdateDate": "06/27/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "133N00000X",
          "TaxonomyName": "Nutritionist",
          "LicenseNumber": "DX7061",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133N00000X",
          "TaxonomyName": "Nutritionist",
          "LicenseNumber": "DN008941",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "133NN1002X",
          "TaxonomyName": "Nutrition Education Nutritionist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}