Provider Demographics
NPI:1568518256
Name:BJORSON, BREIN
Entity Type:Individual
Prefix:
First Name:BREIN
Middle Name:
Last Name:BJORSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREIN
Other - Middle Name:
Other - Last Name:MARZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:152 WOLCOTT DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6561
Mailing Address - Country:US
Mailing Address - Phone:330-518-3253
Mailing Address - Fax:
Practice Address - Street 1:152 WOLCOTT DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-2854
Practice Address - Country:US
Practice Address - Phone:330-518-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5004079Medicaid
OH2462437Medicaid