Provider Demographics
NPI:1295038321
Name:HARLESS, BRENDA KAY (RN)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:KAY
Last Name:HARLESS
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 1:721 ALLYN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1666
Mailing Address - Country:US
Mailing Address - Phone:330-328-7111
Mailing Address - Fax:330-535-9925
Practice Address - Street 1:721 ALLYN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1666
Practice Address - Country:US
Practice Address - Phone:330-328-7111
Practice Address - Fax:330-535-9925
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-12
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN287247163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse