Provider Demographics
NPI:1548713225
Name:STAFFREY, BRENDA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:STAFFREY
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 1:553 S SCHENLEY AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-3027
Mailing Address - Country:US
Mailing Address - Phone:330-509-2481
Mailing Address - Fax:
Practice Address - Street 1:553 S SCHENLEY AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-3027
Practice Address - Country:US
Practice Address - Phone:330-509-2481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN131989164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse