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General NPI Number Information
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NPI Number | 1861341893
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Entity Type | Individual
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Provider Name | MARY ALICE BRANDON RN, CLNC,CIC
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Gender | Female
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 20620 RIVER RD
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City | SUTHERLAND
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State | VA
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Zip | 23885-9539
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Country | US
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Telephone | 804-691-3193
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Fax | 804-691-3193
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Provider Business Mailing Address
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Address Line | 20620 RIVER RD
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City | SUTHERLAND
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State | VA
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Zip | 23885-9539
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Country | US
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Telephone | 804-691-3193
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Fax | 804-691-3193
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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 | 163WI0600X
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Taxonomy Name | Infection Control Registered Nurse
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License Number | 123-4054-731184
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001180795
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License Number State | VA
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