Healthcare Provider Details

I. General information

NPI: 1770602583
Provider Name (Legal Business Name): BRENDA B BLUE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

1218 MERCHANT LN
MCLEAN VA
22101-2411
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-8453
  • Fax: 202-223-9789
Mailing address:
  • Phone: 202-223-8453
  • Fax: 202-223-9789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN64003
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: