Organization Name: | BRANDELENE WELLNESS & SPA, PLLC |
NPI Number: | 1033565296 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRANDIE LEWTHWAITE (PARTNER) |
Mailing Address: | 100 S Main St Duncanville |
State: | TX US |
Postal Code: | 751164732 |
Phone Number: | 9727624952 |
Fax Number: | |
NPI Enumeration Date: | 05/06/2016 |
NPI Last Update Date: | 05/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | 737648 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |