Healthcare Provider Details

I. General information

NPI: 1881756690
Provider Name (Legal Business Name): BRENDA LYNN STROM RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 E GUADALUPE RD PATTERSON ELEMENTARY
GILBERT AZ
85234-4889
US

IV. Provider business mailing address

2531 E LIBRA ST
GILBERT AZ
85234-1108
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-2803
  • Fax: 480-926-3674
Mailing address:
  • Phone: 480-545-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN049399
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: