Healthcare Provider Details

I. General information

NPI: 1740310358
Provider Name (Legal Business Name): BRENDA KAE RIZZO CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 GLENSIDE LN
POWELL OH
43065-9485
US

IV. Provider business mailing address

469 GLENSIDE LN
POWELL OH
43065-9485
US

V. Phone/Fax

Practice location:
  • Phone: 740-549-2217
  • Fax:
Mailing address:
  • Phone: 740-549-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN156563
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: