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General NPI Number Information
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NPI Number | 1821002718
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Entity Type | Individual
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Provider Name | BRENDA BREEDEN UNDERWOOD APRN
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 800 ZORN AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-1433
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Country | US
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Telephone | 502-287-5653
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Fax | 502-287-6906
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Provider Business Mailing Address
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Address Line | 2720 LAMONT RD
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City | LOUISVILLE
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State | KY
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Zip | 40205-2752
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Country | US
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Telephone | 502-459-7324
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Fax | 502-459-7324
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4477P
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License Number State | KY
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