Provider Demographics
NPI:1386231389
Name:BRADY, CAROLYN ANN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:BRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W CUMBERLAND ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45338-8912
Mailing Address - Country:US
Mailing Address - Phone:937-203-9585
Mailing Address - Fax:
Practice Address - Street 1:525 W CUMBERLAND ST APT 1A
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:45338-8912
Practice Address - Country:US
Practice Address - Phone:937-203-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide