Provider Demographics
NPI:1093008286
Name:WARTHER, BRENDA SUE (LPN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:WARTHER
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 1:1921 TREMONT AVE SE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-7035
Mailing Address - Country:US
Mailing Address - Phone:330-418-5900
Mailing Address - Fax:
Practice Address - Street 1:1921 TREMONT AVE SE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-7035
Practice Address - Country:US
Practice Address - Phone:330-418-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.126240-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse