Provider Demographics
NPI:1023863396
Name:MOWRER, BRYNN
Entity type:Individual
Prefix:
First Name:BRYNN
Middle Name:
Last Name:MOWRER
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 1:30 CARDINGTON LN
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:OH
Mailing Address - Zip Code:44214-9427
Mailing Address - Country:US
Mailing Address - Phone:330-317-7964
Mailing Address - Fax:
Practice Address - Street 1:30 CARDINGTON LN
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:OH
Practice Address - Zip Code:44214-9427
Practice Address - Country:US
Practice Address - Phone:330-317-7964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVB852775347C00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle