Provider Demographics
NPI:1609466721
Name:BEAZLIE, BRENDA (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BEAZLIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2912
Mailing Address - Country:US
Mailing Address - Phone:330-762-6110
Mailing Address - Fax:330-253-6810
Practice Address - Street 1:10 PENFIELD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2912
Practice Address - Country:US
Practice Address - Phone:330-762-6110
Practice Address - Fax:330-253-6810
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH317617163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult