=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982775755
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA P CHENEY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1139 LEXINGTON AVE
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31404-5502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-303-4200
-----------------------------------------------------
Fax | 912-790-2701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 DORSET CT
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31410-3177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-898-1171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN127960
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------