Provider Demographics
NPI:1427269786
Name:CAPP, BRENDA MERNA (RN REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MERNA
Last Name:CAPP
Suffix:
Gender:F
Credentials:RN REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:MERNA
Other - Last Name:HIRTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN REGISTERED NURSE
Mailing Address - Street 1:6307 OLD WOODS ROAD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004
Mailing Address - Country:US
Mailing Address - Phone:440-992-8051
Mailing Address - Fax:
Practice Address - Street 1:6307 OLD WOODS ROAD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004
Practice Address - Country:US
Practice Address - Phone:440-992-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH324806163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse