Provider Demographics
NPI:1639450984
Name:GRESOCK, BRANDY ANNE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:ANNE MARIE
Last Name:GRESOCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 CHEYENNE BLVD
Mailing Address - Street 2:APT 53
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1773
Mailing Address - Country:US
Mailing Address - Phone:419-280-2549
Mailing Address - Fax:
Practice Address - Street 1:2417 CHEYENNE BLVD
Practice Address - Street 2:APT 53
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1773
Practice Address - Country:US
Practice Address - Phone:419-280-2549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2013-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131-420 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse