Individual
BRANDIE MUSTARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3018 MY TABOR RD, WAVERLY, OH 45690
(740) 703-9958
Mailing address
3018 MOUNT TABOR RD, WAVERLY, OH 45690-9522
(740) 703-9958
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
M7100881
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3048017
—
OH
Enumeration date
10/15/2020
Last updated
10/15/2020
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