Provider Demographics
NPI:1780184838
Name:REXRODE, BRIANA LYNN
Entity Type:Individual
Prefix:MISS
First Name:BRIANA
Middle Name:LYNN
Last Name:REXRODE
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 1:16198 L P BAILEY MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:NATHALIE
Mailing Address - State:VA
Mailing Address - Zip Code:24577-3300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16198 L P BAILEY MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:NATHALIE
Practice Address - State:VA
Practice Address - Zip Code:24577-3300
Practice Address - Country:US
Practice Address - Phone:434-579-6264
Practice Address - Fax:434-579-6264
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA201301133OtherEMERGENCY MEDICAL RESPONDER