Healthcare Provider Details

I. General information

NPI: 1720034440
Provider Name (Legal Business Name): BRENDA RUNYON DEERE MA, LPA, CPLC, CPWLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA ELISE DEERE MA, CPLC, CPWLC

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14466 REFLECTION LAKES DR
FORT MYERS FL
33907-1806
US

IV. Provider business mailing address

14466 REFLECTION LAKES DR
FORT MYERS FL
33907-1806
US

V. Phone/Fax

Practice location:
  • Phone: 239-791-8679
  • Fax:
Mailing address:
  • Phone: 239-791-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: