Provider Demographics
NPI:1790179216
Name:FOSNOT, BRANDI SUE (LPN)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:SUE
Last Name:FOSNOT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:BRANDI
Other - Middle Name:SUE
Other - Last Name:BOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:6282 OLD TROY PIKE
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3647
Mailing Address - Country:US
Mailing Address - Phone:937-414-8561
Mailing Address - Fax:
Practice Address - Street 1:6282 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3647
Practice Address - Country:US
Practice Address - Phone:937-414-8561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN151503-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse