Provider Demographics
NPI:1447018718
Name:STANG, BRANDY RENAE
Entity type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:RENAE
Last Name:STANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E BISMARCK EXPY APT 2
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6346
Mailing Address - Country:US
Mailing Address - Phone:701-215-6349
Mailing Address - Fax:
Practice Address - Street 1:3601 21ST ST SE APT 102
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-1380
Practice Address - Country:US
Practice Address - Phone:701-209-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND570493747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant