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General NPI Number Information
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NPI Number | 1972068716
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Entity Type | Individual
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Provider Name | BRENDA MUHOMA DNP, FNP, RN
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Gender | Female
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 125 ROCKEFELLER RD
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City | DELMAR
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State | NY
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Zip | 12054-2221
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Country | US
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Telephone | 209-225-5620
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Fax |
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Provider Business Mailing Address
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Address Line | 842 LOUISA LN
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City | LITHONIA
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State | GA
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Zip | 30058-6187
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Country | US
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Telephone | 209-225-5620
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN263300
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN263300
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 353529
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License Number State | NY
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