Healthcare Provider Details

I. General information

NPI: 1376058412
Provider Name (Legal Business Name): BRENDA HILL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 OLD BRANCH AVE STE 409
CLINTON MD
20735-1644
US

IV. Provider business mailing address

9681 BERGAMONT CT
WALDORF MD
20603-5701
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-7121
  • Fax: 301-877-1934
Mailing address:
  • Phone: 301-792-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR150616
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: