Provider Demographics
NPI:1710188347
Name:MYERS, BRENDA LEA
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEA
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1693
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-1693
Mailing Address - Country:US
Mailing Address - Phone:440-813-2956
Mailing Address - Fax:
Practice Address - Street 1:4632 S RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4649
Practice Address - Country:US
Practice Address - Phone:440-813-2956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide