Provider Demographics
NPI:1992311682
Name:BRENEMAN, BRENDA SUE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:BRENEMAN
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 1:6676 KERR RD
Mailing Address - Street 2:
Mailing Address - City:GAMBIER
Mailing Address - State:OH
Mailing Address - Zip Code:43022-9763
Mailing Address - Country:US
Mailing Address - Phone:740-507-4684
Mailing Address - Fax:
Practice Address - Street 1:6740 KERR RD
Practice Address - Street 2:
Practice Address - City:GAMBIER
Practice Address - State:OH
Practice Address - Zip Code:43022
Practice Address - Country:US
Practice Address - Phone:740-427-4087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker