Brenda J Life, CNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

NP-00697 Issued in OH

Practice address

125 E Broad St
Suite 305
Elyria, OH 44035-6400

Phone

(440) 326-4120

Fax

(440) 322-3454

NPI assigned

Jan 26, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: blife28126@ehrdirect.uhhospitals.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302134400000",
    "number": "1073583480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 MOORE RD",
            "address_2": "SUITE B",
            "city": "AVON",
            "state": "OH",
            "postal_code": "440114044",
            "telephone_number": "440-930-4446",
            "fax_number": "440-934-0682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 E BROAD ST",
            "address_2": "SUITE 305",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440356400",
            "telephone_number": "440-326-4120",
            "fax_number": "440-322-3454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIFE",
        "first_name": "BRENDA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-26",
        "last_updated": "2011-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "NP-00697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000342753",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2210744",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "500004284",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Katherine A Lightner
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• Adult Health Nurse Practitioner in Elyria, OH
• Providers in Elyria, OH by specialty
• Adult Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.