Healthcare Provider Details

I. General information

NPI: 1669669594
Provider Name (Legal Business Name): BRENDA WINDEMUTH CRNP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 REDDEN FERRY RD
EDEN MD
21822-2232
US

IV. Provider business mailing address

3580 REDDEN FERRY RD
EDEN MD
21822-2232
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-8224
  • Fax: 410-546-8224
Mailing address:
  • Phone: 410-546-8224
  • Fax: 410-546-8224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BRENDA FAY WINDEMUTH
Title or Position: OWNER
Credential: CRNP
Phone: 410-546-8224