Provider Demographics
NPI:1902343213
Name:BRASS, JESSICA (LPN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BRASS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-0433
Mailing Address - Country:US
Mailing Address - Phone:440-563-1149
Mailing Address - Fax:
Practice Address - Street 1:2531 FORMAN RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-9750
Practice Address - Country:US
Practice Address - Phone:440-563-1149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH119845164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse