MEDICARE: BRIONNA MARIE EASLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver		OH
2	376J00000X	Homemaker		OH

General Provider Information

NPI Number	:	1932949245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIONNA MARIE EASLEY

Provider Business Mailing Address
First Line	:	4664 PENRIDGE RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1104
Country	:	US
Telephone Number	:	419-508-4038
Fax Number	:

Provider Business Practice Location Address
First Line	:	4664 PENRIDGE RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1104
Country	:	US
Telephone Number	:	419-508-4038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2024
Last Update Date	:	05/27/2024

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Directions to “ BRIONNA MARIE EASLEY ” Practice Location

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