Healthcare Provider Details

I. General information

NPI: 1033352273
Provider Name (Legal Business Name): LISA BRENDLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

3200 HOSPITAL DR SUITE100
JUNEAU AK
99801-7829
US

V. Phone/Fax

Practice location:
  • Phone: 907-523-5962
  • Fax: 888-789-8047
Mailing address:
  • Phone: 907-523-5962
  • Fax: 888-789-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number21595
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: