Healthcare Provider Details

I. General information

NPI: 1346430402
Provider Name (Legal Business Name): BRENDA BELLMANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8377 BLISS RD
ELIDA OH
45807-9483
US

IV. Provider business mailing address

8377 BLISS RD
ELIDA OH
45807-9483
US

V. Phone/Fax

Practice location:
  • Phone: 419-339-6149
  • Fax:
Mailing address:
  • Phone: 419-339-6149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.214099
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN.214099
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: