Healthcare Provider Details

I. General information

NPI: 1194998039
Provider Name (Legal Business Name): BRENDA L PERRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA L HAYNIE NP

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 Q ST
SACRAMENTO CA
95816-7058
US

IV. Provider business mailing address

3000 Q ST
SACRAMENTO CA
95816-7058
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-3390
  • Fax: 916-733-3450
Mailing address:
  • Phone: 916-733-3390
  • Fax: 916-733-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: