Provider Demographics
NPI:1184387185
Name:HUYA, BRENDA LEE (LPN)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:HUYA
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 1:1071 SANFORD ST
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-1514
Mailing Address - Country:US
Mailing Address - Phone:440-412-7100
Mailing Address - Fax:440-353-0066
Practice Address - Street 1:6200 LEAR NAGLE RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3224
Practice Address - Country:US
Practice Address - Phone:440-412-7100
Practice Address - Fax:440-353-0066
Is Sole Proprietor?:No
Enumeration Date:2021-10-16
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH104686164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse