Provider Demographics
NPI:1932795937
Name:BRADY, ELISABETH RENEE
Entity type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:RENEE
Last Name:BRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 WASHINGTON WATERLOO RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-8717
Mailing Address - Country:US
Mailing Address - Phone:740-335-2423
Mailing Address - Fax:740-333-5182
Practice Address - Street 1:3711 WASHINGTON WATERLOO RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-8717
Practice Address - Country:US
Practice Address - Phone:740-335-2423
Practice Address - Fax:740-333-5182
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant