Provider Demographics
NPI:1649498460
Name:HEAD, BRENDAER M (LPN)
Entity type:Individual
Prefix:MRS
First Name:BRENDAER
Middle Name:M
Last Name:HEAD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:M
Other - Last Name:HEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:9915 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-5455
Mailing Address - Country:US
Mailing Address - Phone:216-883-2468
Mailing Address - Fax:
Practice Address - Street 1:9915 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-5455
Practice Address - Country:US
Practice Address - Phone:215-883-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 052847164W00000X
OHPN 052847164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse