Provider Demographics
NPI:1164805313
Name:BRANTLEY, SARETHA (LPN)
Entity type:Individual
Prefix:MRS
First Name:SARETHA
Middle Name:
Last Name:BRANTLEY
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 1:8627 DESOTO DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-4407
Mailing Address - Country:US
Mailing Address - Phone:513-609-2827
Mailing Address - Fax:
Practice Address - Street 1:8627 DESOTO DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4407
Practice Address - Country:US
Practice Address - Phone:513-609-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0102290374U00000X
OH188774164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1164805313Medicaid