MEDICARE: BRENDA WINDEMUTH CRNP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1669669594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENDA WINDEMUTH CRNP LLC

Provider Business Mailing Address
First Line	:	3580 REDDEN FERRY RD
Second Line	:
City	:	EDEN
State	:	MD
Zip	:	21822-2232
Country	:	US
Telephone Number	:	410-546-8224
Fax Number	:	410-546-8224

Provider Business Practice Location Address
First Line	:	3580 REDDEN FERRY RD
Second Line	:
City	:	EDEN
State	:	MD
Zip	:	21822-2232
Country	:	US
Telephone Number	:	410-546-8224
Fax Number	:	410-546-8224

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BRENDA FAY WINDEMUTH
Credential	:	CRNP
Telephone Number	:	410-546-8224

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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