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General NPI Number Information
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NPI Number | 1659097095
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Entity Type | Individual
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Provider Name | BRANDYWINE N HIGHTOWER IDHS
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Gender | Female
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 3823 MAIN ST
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City | CHINCOTEAGUE
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State | VA
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Zip | 23336-1857
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Country | US
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Telephone | 757-336-2844
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Fax | 757-336-2811
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Provider Business Mailing Address
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Address Line | 3823 MAIN ST
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City | CHINCOTEAGUE
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State | VA
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Zip | 23336-1857
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Country | US
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Telephone | 757-336-2844
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Fax | 757-336-2811
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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 | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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