Healthcare Provider Details

I. General information

NPI: 1366950511
Provider Name (Legal Business Name): BRENDA DEAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 PINECREST ST NE
CANTON OH
44721-2806
US

IV. Provider business mailing address

7050 PINECREST ST NE
CANTON OH
44721-2806
US

V. Phone/Fax

Practice location:
  • Phone: 330-323-9437
  • Fax:
Mailing address:
  • Phone: 330-323-9437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN247692
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN247692
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: