Provider Demographics
NPI:1376684761
Name:OSSOVICKI, BRENDA MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:MARIE
Last Name:OSSOVICKI
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 1:3914 SCHILLER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4864
Mailing Address - Country:US
Mailing Address - Phone:216-739-0255
Mailing Address - Fax:
Practice Address - Street 1:3914 SCHILLER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4864
Practice Address - Country:US
Practice Address - Phone:216-739-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN092236164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse