Healthcare Provider Details

I. General information

NPI: 1528982048
Provider Name (Legal Business Name): MS. RANA LYNN BROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 FULTON AVE
MORAINE OH
45439-2120
US

IV. Provider business mailing address

6479 REFLECTIONS DR STE 230
DUBLIN OH
43017-2366
US

V. Phone/Fax

Practice location:
  • Phone: 888-343-2758
  • Fax:
Mailing address:
  • Phone: 888-343-2758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.008115
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: