Healthcare Provider Details

I. General information

NPI: 1477371482
Provider Name (Legal Business Name): BRENDA O AYENSU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9692 NORFOLK AVE
LAUREL MD
20723-1883
US

IV. Provider business mailing address

9692 NORFOLK AVE
LAUREL MD
20723-1883
US

V. Phone/Fax

Practice location:
  • Phone: 240-565-9796
  • Fax:
Mailing address:
  • Phone: 240-565-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR244751
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR244751
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR244751
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR244751
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR244751
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberR244751
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR244751
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR244751
License Number StateMD
# 9
Primary TaxonomyY
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License NumberR244751
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: