Provider Demographics
NPI:1295751238
Name:BRENEMAN, GAIL ANN (RN)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:ANN
Last Name:BRENEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16667 PAVER BARNES RD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9151
Mailing Address - Country:US
Mailing Address - Phone:937-243-2631
Mailing Address - Fax:
Practice Address - Street 1:18864 STATE ROUTE 245
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9655
Practice Address - Country:US
Practice Address - Phone:937-644-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN274667163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2277110Medicaid