Provider Demographics
NPI:1013511468
Name:BRENT, CHERYL MARIE (STNA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:BRENT
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 GOODYEAR BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-3528
Mailing Address - Country:US
Mailing Address - Phone:440-381-5611
Mailing Address - Fax:
Practice Address - Street 1:120 BROOKMONT RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-3089
Practice Address - Country:US
Practice Address - Phone:330-666-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400910750509376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH400910750509OtherSTNA