Provider Demographics
NPI:1407234396
Name:WEEMAN, BRENT R (RN, BSN)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:R
Last Name:WEEMAN
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 N KANSAS RD
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-9242
Mailing Address - Country:US
Mailing Address - Phone:330-464-9485
Mailing Address - Fax:
Practice Address - Street 1:880 N KANSAS RD
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-9242
Practice Address - Country:US
Practice Address - Phone:330-464-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.413435163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse