Healthcare Provider Details

I. General information

NPI: 1104448653
Provider Name (Legal Business Name): BRIAN PATRICK BERENDTS APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML3014 PSYCHIATRY
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

MEDICAL STAFF SERVICES 3333 BURNET AVE., MLC 5021
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4788
  • Fax: 513-636-4283
Mailing address:
  • Phone: 513-636-5278
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0026891
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: