Provider Demographics
NPI:1346029790
Name:FEARS, BRENDA KAYE (STNA)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:KAYE
Last Name:FEARS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S BYRNE RD APT A216
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2359
Mailing Address - Country:US
Mailing Address - Phone:419-984-3976
Mailing Address - Fax:
Practice Address - Street 1:1255 S BYRNE RD APT A216
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2359
Practice Address - Country:US
Practice Address - Phone:419-984-3976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400155580802376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide