Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | COA.13794-NP | OH |
NPI | 1013266774 |
---|---|
Provider Name | Brian Lee Vereb |
First Address | Fairlawn, OH 44333-9294 |
Second Address | Fairlawn, OH 44333-9294 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2012 |
Last Update Date | 14/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0077984 | (05) | OH |
1841239274 | PARTNERS PHYSICIAN GROUP TYPE 2 NPI # (01) | OH |
2551671 | PARTNERS PHYSICIAN GROUP MEDICAID GROUP # (01) | OH |
9338635 | PARTNERS PHYSICIAN GROUP MEDICARE GROUP # (01) | OH |