Provider Demographics
NPI:1962053462
Name:BRICKHAUS, LANNA ROBERTA
Entity type:Individual
Prefix:
First Name:LANNA
Middle Name:ROBERTA
Last Name:BRICKHAUS
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 1:5945 SAWDUST TRAIL
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016
Mailing Address - Country:US
Mailing Address - Phone:314-401-3962
Mailing Address - Fax:
Practice Address - Street 1:5945 SAWDUST TRAIL
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:MO
Practice Address - Zip Code:63016
Practice Address - Country:US
Practice Address - Phone:314-401-3962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider