Individual
BRENDA KIDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7700
(216) 286-6341
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
364SP0200X
Pediatric Clinical Nurse Specialist
Primary
1802-NS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000224407
UNISON
OH
01
—
000000370806
ANTHEM
OH
01
—
000000526071
ANTHEM
OH
01
—
1021104990001
PA MEDICAID
PA
05
—
2776830
—
OH
01
—
363699
WELLCARE
OH
01
—
750700
BUCKEYE
OH
01
—
7876700
AETNA
OH
Enumeration date
07/21/2006
Last updated
06/25/2010
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