Provider Demographics
NPI:1225913593
Name:WIESE, BRANDI (RN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:WIESE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 S DICKSON ST
Mailing Address - Street 2:
Mailing Address - City:KEENESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80643-9032
Mailing Address - Country:US
Mailing Address - Phone:720-383-3733
Mailing Address - Fax:
Practice Address - Street 1:170 S DICKSON ST
Practice Address - Street 2:
Practice Address - City:KEENESBURG
Practice Address - State:CO
Practice Address - Zip Code:80643-9032
Practice Address - Country:US
Practice Address - Phone:720-383-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1649006163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency