Basic Information
| Provider Information | |||||||||
| NPI: | 1013511468 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRENT | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | STNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1706 GOODYEAR BLVD | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443053528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403815611 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 BROOKMONT RD | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443333089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306667373 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2020 | ||||||||
| LastUpdateDate: | 11/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | 400910750509 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Nurse's Aide |
ID Information
| ID | Type | State | Issuer | Description | 400910750509 | 01 | OH | STNA | OTHER |