1396005559 NPI number — BONNIE J BRAHANEY CNP

Table of content: BONNIE J BRAHANEY CNP (NPI 1396005559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396005559 NPI number — BONNIE J BRAHANEY CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAHANEY
Provider First Name:
BONNIE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396005559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 SEAGATE STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-1558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-824-6599
Provider Business Mailing Address Fax Number:
419-882-3870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5308 HARROUN RD
Provider Second Line Business Practice Location Address:
SUITE 055
Provider Business Practice Location Address City Name:
SYLVANIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43560-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-824-6599
Provider Business Practice Location Address Fax Number:
419-885-3870
Provider Enumeration Date:
05/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN.199232 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0068423 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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