Provider Demographics
NPI:1497379309
Name:BRANT, DENEEN MARIE VIOLA
Entity Type:Individual
Prefix:
First Name:DENEEN MARIE
Middle Name:VIOLA
Last Name:BRANT
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 1:231 COMANCHE PL
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4429
Mailing Address - Country:US
Mailing Address - Phone:440-731-9098
Mailing Address - Fax:
Practice Address - Street 1:708 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3308
Practice Address - Country:US
Practice Address - Phone:330-983-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRW248909374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0358944Medicaid