Healthcare Provider Details

I. General information

NPI: 1104210723
Provider Name (Legal Business Name): BRADY PICKFORD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W HIGH ST STE 360
LIMA OH
45801-3985
US

IV. Provider business mailing address

830 W HIGH ST STE 360
LIMA OH
45801-3985
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-7117
  • Fax: 419-227-2848
Mailing address:
  • Phone: 419-227-7117
  • Fax: 419-227-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0043462
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: