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General NPI Number Information
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NPI Number | 1114611910
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Entity Type | Individual
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Provider Name | BRENDA LUKE
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Gender | Female
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 1489 LOST LAKE CT
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City | WILLIAMSBURG
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State | OH
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Zip | 45176-9666
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Country | US
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Telephone | 513-259-8204
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Fax |
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Provider Business Mailing Address
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Address Line | 2309 OREILLY ROAD
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City | FAYETTEVILLE
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State | OH
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Zip | 45118-9766
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Country | US
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Telephone | 513-537-2764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 0154927088
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License Number State | VA
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