Healthcare Provider Details

I. General information

NPI: 1861730178
Provider Name (Legal Business Name): BRENDA LEE NEWHOUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA LEE RICKMAN

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12965 BEESON ST NE
ALLIANCE OH
44601-8708
US

IV. Provider business mailing address

12965 BEESON ST NE
ALLIANCE OH
44601-8708
US

V. Phone/Fax

Practice location:
  • Phone: 330-581-3771
  • Fax:
Mailing address:
  • Phone: 330-581-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number378566061099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: