Healthcare Provider Details

I. General information

NPI: 1861881575
Provider Name (Legal Business Name): BRENDA K DEQUASIE APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33101 HILAND RD SUITE B
POMEROY OH
45769-9759
US

IV. Provider business mailing address

33101 HILAND RD SUITE B
POMEROY OH
45769-9759
US

V. Phone/Fax

Practice location:
  • Phone: 740-992-0220
  • Fax: 740-992-0223
Mailing address:
  • Phone: 740-992-0220
  • Fax: 740-992-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55406
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA 18497-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: