Provider Demographics
NPI:1346205234
Name:BROWN, BRENDA (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BROWN
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:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:ROSS
Mailing Address - State:OH
Mailing Address - Zip Code:45061-0485
Mailing Address - Country:US
Mailing Address - Phone:513-623-0305
Mailing Address - Fax:513-738-3038
Practice Address - Street 1:4871 PROSPERITY PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-4027
Practice Address - Country:US
Practice Address - Phone:513-623-0305
Practice Address - Fax:513-738-3038
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN243247163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2279074Medicaid
OH2279074Medicaid
OHBRNS01493Medicare ID - Type Unspecified
KY0695302Medicare ID - Type Unspecified