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General NPI Number Information
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NPI Number | 1225800915
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Entity Type | Individual
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Provider Name | GWENDOLYN HOPE BRODESS
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Gender | Female
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 314 1/2 EAST THIRD ST
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City | PIKETON
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State | OH
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Zip | 45661
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Country | US
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Telephone | 740-708-3480
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Fax |
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Provider Business Mailing Address
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Address Line | 314 1/2 EAST THIRD ST.
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City | PIKETON
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State | OH
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Zip | 45661
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Country | US
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Telephone | 740-708-3480
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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 | 0058859
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License Number State | OH
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