Provider Demographics
NPI:1649587197
Name:HORNER, BRANDY MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:MICHELLE
Last Name:HORNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRANDY
Other - Middle Name:MICHELLE
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 N GOODBREAD ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:OH
Mailing Address - Zip Code:44849-9452
Mailing Address - Country:US
Mailing Address - Phone:419-569-6684
Mailing Address - Fax:
Practice Address - Street 1:411 N GOODBREAD ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:OH
Practice Address - Zip Code:44849-9452
Practice Address - Country:US
Practice Address - Phone:419-569-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-04
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN363862163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse