Provider Demographics
NPI:1629612882
Name:HENTOSZ, BRITTANY (CNP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:HENTOSZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 STATE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3600
Mailing Address - Country:US
Mailing Address - Phone:330-253-9727
Mailing Address - Fax:330-926-5866
Practice Address - Street 1:3033 STATE RD STE 204
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3600
Practice Address - Country:US
Practice Address - Phone:330-253-9727
Practice Address - Fax:330-926-5866
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF09190241363LF0000X
OHAPRN.CNP.025593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0379508Medicaid