Provider Demographics
NPI:1013396506
Name:BIRD, BRENNA MARY MAE (EDS)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:MARY MAE
Last Name:BIRD
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 MADISON RD
Mailing Address - Street 2:APT. #5
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1898
Mailing Address - Country:US
Mailing Address - Phone:412-997-2601
Mailing Address - Fax:
Practice Address - Street 1:3371 HAMILTON CLEVES RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-9535
Practice Address - Country:US
Practice Address - Phone:513-863-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3175649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist