Healthcare Provider Details

I. General information

NPI: 1659395481
Provider Name (Legal Business Name): ALLISON BRANDENBURG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 EAST CROSS ST
ANSONIA OH
45303
US

IV. Provider business mailing address

PO BOX 381
ANSONIA OH
45303-0381
US

V. Phone/Fax

Practice location:
  • Phone: 937-417-5675
  • Fax: 937-337-0241
Mailing address:
  • Phone: 937-417-5675
  • Fax: 937-337-0241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: