Provider Demographics
NPI:1235331083
Name:LETT, BRENON (LPN)
Entity Type:Individual
Prefix:
First Name:BRENON
Middle Name:
Last Name:LETT
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 CLARKWOOD PKWY APT 114
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44128
Mailing Address - Country:US
Mailing Address - Phone:216-701-6389
Mailing Address - Fax:
Practice Address - Street 1:4361 CLARKWOOD PKWY APT 114
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-4872
Practice Address - Country:US
Practice Address - Phone:216-701-6389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN116887164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse