Individual
BRENDA NICHOLS-OMIECINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
13207 RAVENNA RD, CHARDON, OH 44024-7032
(440) 285-6000
Mailing address
PO BOX 526, NOVELTY, OH 44072-0526
(440) 285-6000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN166962
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
RN166962
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221285
UNISON
OH
01
—
000000516002
ANTHEM
OH
01
—
0583328
BCMH
OH
05
—
2389339
—
OH
01
—
415014
WELLCARE MEDICAID
OH
01
—
750937
BUCKEYE MEDICAID
OH
01
—
7516119
AETNA
OH
01
—
P00403006
MEDICARE RAILROAD
OH
Enumeration date
05/18/2006
Last updated
01/10/2025
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