Provider Demographics
NPI:1720264567
Name:YOUNG, BRANDI YVONNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:YVONNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:BRANDI
Other - Middle Name:YVONNE
Other - Last Name:YOUNG-ROACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:13634 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:CLEVE.
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-856-0012
Mailing Address - Fax:
Practice Address - Street 1:18613 HARLAN DR
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2235
Practice Address - Country:US
Practice Address - Phone:216-587-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH109465164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse