Provider Demographics
NPI:1740989797
Name:NORMAN, BRENDA J
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:NORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:J
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3626 SILVIEUS ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4141
Mailing Address - Country:US
Mailing Address - Phone:208-436-4368
Mailing Address - Fax:
Practice Address - Street 1:3626 SILVIEUS ST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4141
Practice Address - Country:US
Practice Address - Phone:208-436-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker