Provider Demographics
NPI:1841570009
Name:HILL, BRANDIS MAIYA (RN)
Entity Type:Individual
Prefix:MS
First Name:BRANDIS
Middle Name:MAIYA
Last Name:HILL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3677 LUDGATE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5069
Mailing Address - Country:US
Mailing Address - Phone:216-209-7987
Mailing Address - Fax:216-588-1078
Practice Address - Street 1:3677 LUDGATE RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-5069
Practice Address - Country:US
Practice Address - Phone:216-209-7987
Practice Address - Fax:216-588-1078
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH463970163WH0200X, 163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0124117Medicaid