MEDICARE: BRANDEE FANCHON DAMIANO CRM

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	175T00000X	Peer Specialist	21-CRM-341	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21-CRM-341	OTHER	OR	CRM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598359804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDEE FANCHON DAMIANO CRM

Provider Business Mailing Address
First Line	:	505 WASHINGTON ST APT A3
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2257
Country	:	US
Telephone Number	:	503-732-5128
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 WASHINGTON ST APT A3
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2257
Country	:	US
Telephone Number	:	503-732-5128
Fax Number	:

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

Provider Enumeration Date	:	02/26/2021
Last Update Date	:	02/26/2021

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