Healthcare Provider Details

I. General information

NPI: 1750106126
Provider Name (Legal Business Name): TAWANYA E BRIME LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 E BROAD ST
WHITEHALL OH
43213-1156
US

IV. Provider business mailing address

4040 E BROAD ST
WHITEHALL OH
43213-1156
US

V. Phone/Fax

Practice location:
  • Phone: 614-350-1970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN129503
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: