Individual
MARYANNA KATHRYN BROCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
275 N BREIEL BLVD, MIDDLETOWN, OH 45042-3807
(513) 424-7711
Mailing address
30 CLEVENGER CT, SPRINGBORO, OH 45066-7429
(937) 422-3449
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
50.007758RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IEDAN6392435
ANTHEM BLUECROSS BLUESHIELD
OH
Enumeration date
01/29/2018
Last updated
08/19/2025
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