Provider Demographics
NPI:1437337474
Name:DEESER, BRENDA S (CNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:DEESER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:S
Other - Last Name:MANSFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:444 W EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1711
Mailing Address - Country:US
Mailing Address - Phone:330-535-2671
Mailing Address - Fax:
Practice Address - Street 1:444 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1711
Practice Address - Country:US
Practice Address - Phone:330-535-2671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.08623-NP363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2825821Medicaid
DANP25931Medicare PIN
OHH373946Medicare PIN