MEDICARE: MRS. CAITLIN ELIZABETH BRANDT PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	1671156	CO
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0996416-NP	CO

General Provider Information

NPI Number	:	1083209738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAITLIN ELIZABETH BRANDT PMHNP

Provider Business Mailing Address
First Line	:	3959 REINDEER CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-6101
Country	:	US
Telephone Number	:	609-234-9889
Fax Number	:

Provider Business Practice Location Address
First Line	:	3959 REINDEER CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80922-6101
Country	:	US
Telephone Number	:	609-234-9889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	12/02/2021

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