Provider Demographics
NPI:1235336637
Name:BRADY, BEVERLY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:BRADY
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 1:5080 CUBA RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-8656
Mailing Address - Country:US
Mailing Address - Phone:937-655-7295
Mailing Address - Fax:
Practice Address - Street 1:5080 CUBA RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-8656
Practice Address - Country:US
Practice Address - Phone:937-655-7295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 076577164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse