Basic Information
Provider Information
NPI: 1033558549
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEWEES
FirstName: BRANDON
MiddleName: N.
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3605 MURDOCH AVE
Address2:  
City: PARKERSBURG
State: WV
PostalCode: 261011026
CountryCode: US
TelephoneNumber: 3044852700
FaxNumber: 3044850481
Practice Location
Address1: 90 JACKSON PIKE
Address2:  
City: GALLIPOLIS
State: OH
PostalCode: 456311560
CountryCode: US
TelephoneNumber: 7404465287
FaxNumber: 7404465854
Other Information
ProviderEnumerationDate: 06/18/2013
LastUpdateDate: 04/08/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XCOA.14736-NPOHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
008815805OH MEDICAID
381002623405WV MEDICAID


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