Provider Demographics
NPI:1306461819
Name:FORTNER, BRIANNA (LPN)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:FORTNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 DEER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-5464
Mailing Address - Country:US
Mailing Address - Phone:330-318-2397
Mailing Address - Fax:
Practice Address - Street 1:4521 DEER CREEK CT
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-5464
Practice Address - Country:US
Practice Address - Phone:330-318-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.173527.MEDS-IV251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health