Provider Demographics
NPI:1033523295
Name:ASWAD, BRENDA JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JEAN
Last Name:ASWAD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 EADES RD
Mailing Address - Street 2:
Mailing Address - City:RED CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13143-3151
Mailing Address - Country:US
Mailing Address - Phone:315-754-8707
Mailing Address - Fax:315-754-8707
Practice Address - Street 1:7413 EADES RD
Practice Address - Street 2:
Practice Address - City:RED CREEK
Practice Address - State:NY
Practice Address - Zip Code:13143-3151
Practice Address - Country:US
Practice Address - Phone:315-754-8707
Practice Address - Fax:315-754-8707
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156852164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse