Provider Demographics
NPI:1851493779
Name:CARROLL, BRENDA LEE (RN)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:LEE
Last Name:CARROLL
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 1:3448 VISALIA RD
Mailing Address - Street 2:
Mailing Address - City:MORNING VIEW
Mailing Address - State:KY
Mailing Address - Zip Code:41063-8731
Mailing Address - Country:US
Mailing Address - Phone:859-356-3831
Mailing Address - Fax:859-356-3831
Practice Address - Street 1:3448 VISALIA RD
Practice Address - Street 2:
Practice Address - City:MORNING VIEW
Practice Address - State:KY
Practice Address - Zip Code:41063-8731
Practice Address - Country:US
Practice Address - Phone:859-356-3831
Practice Address - Fax:859-356-3831
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.301641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse