| Doctor Name: | MRS. BRENDA J LIFE |
| NPI Number: | 1073583480 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | NP-00697 |
| Business Practice Address: | 125 E Broad St Suite 305 Elyria, OH - 440356400 |
| Business Phone Number: | 4403264120 |
| Business Fax Number: | 4403223454 |
| Mailing Address: | 1220 Moore Rd, Suite B AVON |
| State: | OH |
| Postal Code: | 440114044 |
| Phone Number: | 4409304446 |
| Fax Number: | 4409340682 |
| NPI Enumeration Date: | 01/26/2006 |
| NPI Last Update Date: | 04/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | NP-00697 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |