Individual
MS. ELIZABETH BARBARA BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-3472
(336) 716-2255
(336) 716-3202
Mailing address
1208 WATSON AVE, WINSTON SALEM, NC 27103-5010
(859) 816-4379
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-12558
NC
363A00000X
Physician Assistant
2019004090
MO
363A00000X
Physician Assistant
C0008113
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220068521
—
MO
Enumeration date
01/06/2019
Last updated
09/23/2022
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