Individual
BRANDI MARIE GRANDE-MATHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
906 W GRANITE ST, GILLETTE, WY 82718-5250
(307) 660-3827
Mailing address
906 W GRANITE ST, GILLETTE, WY 82718-5250
(307) 660-3827
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000000
—
WY
Enumeration date
06/08/2018
Last updated
06/08/2018
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