Healthcare Provider Details

I. General information

NPI: 1558849794
Provider Name (Legal Business Name): BRENDA ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 OAKWOOD HILLS PKWY
EAU CLAIRE WI
54701-7698
US

IV. Provider business mailing address

3440 OAKWOOD HILLS PKWY
EAU CLAIRE WI
54701-7698
US

V. Phone/Fax

Practice location:
  • Phone: 715-214-2510
  • Fax: 715-214-2514
Mailing address:
  • Phone: 715-214-2510
  • Fax: 715-214-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number147537
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: