Provider Demographics
NPI:1891014577
Name:GEDDIS, BRENETTA MARIE
Entity Type:Individual
Prefix:MS
First Name:BRENETTA
Middle Name:MARIE
Last Name:GEDDIS
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 1:247 AYERS ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44506-1529
Mailing Address - Country:US
Mailing Address - Phone:330-519-4074
Mailing Address - Fax:
Practice Address - Street 1:247 AYERS ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44506-1529
Practice Address - Country:US
Practice Address - Phone:330-519-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker