Provider Demographics
NPI:1588118442
Name:TRENT, BRANDI (LPN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:TRENT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:LEIGH
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1448 GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2744
Mailing Address - Country:US
Mailing Address - Phone:419-905-8622
Mailing Address - Fax:
Practice Address - Street 1:1448 GLENN AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2744
Practice Address - Country:US
Practice Address - Phone:419-905-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-130-668-M IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse