Basic Information
| Provider Information | |||||||||
| NPI: | 1275546210 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANDON | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 PEACHTREE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288033505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282743477 | ||||||||
| FaxNumber: | 8282747407 | ||||||||
| Practice Location | |||||||||
| Address1: | 76 PEACHTREE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288033505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282743477 | ||||||||
| FaxNumber: | 8282747407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 153833 | NC | N | Nursing Service Providers | Registered Nurse | 367500000X | 075324 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 8052646 | 05 | NC | MEDICAID |