Healthcare Provider Details

I. General information

NPI: 1083972970
Provider Name (Legal Business Name): BRENDA ENEKE ENO CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9332 ANNAPOLIS RD # SUITE 105
LANHAM MD
20706
US

IV. Provider business mailing address

9332 ANNAPOLIS RD. SUITE 105
LANHAM MD
20706
US

V. Phone/Fax

Practice location:
  • Phone: 301-708-9309
  • Fax: 800-348-2155
Mailing address:
  • Phone: 240-643-4430
  • Fax: 202-503-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1016390
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR178470
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: