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General NPI Number Information
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NPI Number | 1770082182
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Entity Type | Individual
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Provider Name | BRENDA LEE BUB
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Gender | Female
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 817 KILBOURNE ST
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City | BELLEVUE
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State | OH
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Zip | 44811-9431
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Country | US
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Telephone | 567-560-3587
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Fax |
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Provider Business Mailing Address
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Address Line | 3533 AUSTIN DR
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City | WILLARD
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State | OH
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Zip | 44890-9230
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Country | US
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Telephone | 567-227-0376
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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