Provider Demographics
NPI:1649777806
Name:HEARY, BRENDA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:HEARY
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 1:70 CAREFREE LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2223
Mailing Address - Country:US
Mailing Address - Phone:716-602-8330
Mailing Address - Fax:
Practice Address - Street 1:625 DELAWARE AVE STE 150
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1000
Practice Address - Country:US
Practice Address - Phone:716-884-1001
Practice Address - Fax:716-884-1827
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235291-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse