Individual
BRANDI EKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.O.A., S.T.
Contact information
Practice address
1750 E GLENDALE AVE, PHOENIX, AZ 85020-5505
(602) 242-4928
(602) 249-4813
Mailing address
1750 E GLENDALE AVE, PHOENIX, AZ 85020-5505
(602) 242-4928
(602) 249-4813
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
159165
JCAHPO
AZ
Enumeration date
06/11/2015
Last updated
06/11/2015
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