Joyce A Brake
Individual provider Active NPI Licensed Practical Nurse · Fredericktown, OH
NPI 1336404185 · NPPES record last updated Jul 9, 2012
Key facts
- NPI
- 1336404185
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- PN 089562 IV (OH)
- Practice address
- 17 S Mulberry St
Fredericktown, OH 43019-1210 - Phone
- (740) 507-0927
- NPI assigned
- Jul 9, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN 089562 IV | OH | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN 089562 IV | OH | Yes |
Addresses
Primary practice location
17 S Mulberry St
Fredericktown, OH 43019-1210
Mailing address
17 S Mulberry St
Fredericktown, OH 43019-1210
Phone (740) 507-0927
Other providers in Fredericktown, OH
- American Health Network of Ohio, LLC
- Ashlee N Armstrong
- Deborah Avalon
- Danielle Blackford
- Shannon Marie Boeshart
- Robert Eric Burns
- Jennnifer T Butler
- Cassandra Lynn Byers
- Stephanie Campbell
- Carl Lee Coogle
All providers in Fredericktown, OH · Licensed Practical Nurse in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.