Individual
MRS. BRENDA J LIFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
125 E BROAD ST, SUITE 305, ELYRIA, OH 44035-6400
(440) 326-4120
(440) 322-3454
Mailing address
1220 MOORE RD, SUITE B, AVON, OH 44011-4044
(440) 930-4446
(440) 934-0682
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
NP-00697
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000342753
ANTHEM
OH
05
—
2210744
—
OH
01
—
500004284
RAILROAD MEDICARE
—
Enumeration date
01/26/2006
Last updated
04/07/2011
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