Healthcare Provider Details

I. General information

NPI: 1609318427
Provider Name (Legal Business Name): CASEY BRUSHABER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HUGHES DR SUITE 640
TOLEDO OH
43606-3856
US

IV. Provider business mailing address

1564 BRADMORE DR
TOLEDO OH
43612-2013
US

V. Phone/Fax

Practice location:
  • Phone: 567-661-0505
  • Fax:
Mailing address:
  • Phone: 419-360-8980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.424392
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: