Provider Demographics
NPI:1316273907
Name:MARY C BRADY, CNP
Entity type:Organization
Organization Name:MARY C BRADY, CNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:513-310-3007
Mailing Address - Street 1:430 DEANVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-1415
Mailing Address - Country:US
Mailing Address - Phone:513-310-3007
Mailing Address - Fax:
Practice Address - Street 1:430 DEANVIEW DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-1415
Practice Address - Country:US
Practice Address - Phone:513-310-3007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08812363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2975384Medicaid
OH2975384Medicaid