Provider Demographics
NPI:1952687550
Name:MEDELLIN, BRENDA NOHEMI (LPN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:NOHEMI
Last Name:MEDELLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-2308
Mailing Address - Country:US
Mailing Address - Phone:419-255-3057
Mailing Address - Fax:
Practice Address - Street 1:2760 AIRPORT DR
Practice Address - Street 2:130
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2284
Practice Address - Country:US
Practice Address - Phone:614-751-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN145868164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse