Individual
BRENDEN G TULLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2420 LAKE AVE, ASHTABULA, OH 44004-4954
(440) 997-2262
Mailing address
411 CASTLE ROCK RD, BROOKFIELD, OH 44403-8603
(330) 413-7913
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.008422RX
OH
Other
Enumeration date
06/29/2023
Last updated
10/10/2023
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