Basic Information
| Provider Information | |||||||||
| NPI: | 1629148747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANDON | ||||||||
| FirstName: | LOIS | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 328 N MICHIGAN ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466011244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746471069 | ||||||||
| FaxNumber: | 5746471825 | ||||||||
| Practice Location | |||||||||
| Address1: | 316 INDIAN RIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465459034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006355516 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71001004A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.