Provider Demographics
NPI:1093989865
Name:KLINGELSMITH, BRENDA E (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:E
Last Name:KLINGELSMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 WERTZ AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-2036
Mailing Address - Country:US
Mailing Address - Phone:330-409-3872
Mailing Address - Fax:
Practice Address - Street 1:1118 WERTZ AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-2036
Practice Address - Country:US
Practice Address - Phone:330-409-3872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN246947163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse