Most Relevant Information
Provider Data
| NPI Number: | 1003313065 |
| Provider Name: | BRANDON LAMAR HOLLEY |
| Entity Type: | Individual |
| Taxonomy Code: | 172V00000X |
| Specialty: | Community Health Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/06/2018 |
| Last Updated: | 04/06/2018 |
Provider Practice Location
76 PHELPS ST
EAST HARTFORD
CT
061082259
Practice Location Phone/Fax
| Phone: | 8607098781 |
| Fax: |
Provider Mailing Location
76 PHELPS ST
EAST HARTFORD
CT
061082259
Provider Mailing Phone/Fax
| Phone: | 8607098781 |
| Fax: |