Provider Demographics
NPI:1083253033
Name:GARTRELL, BRENDA LEE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:GARTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 RED QUARTZ DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5634
Mailing Address - Country:US
Mailing Address - Phone:917-202-2259
Mailing Address - Fax:
Practice Address - Street 1:2000 RED QUARTZ DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-5634
Practice Address - Country:US
Practice Address - Phone:917-202-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF05190145363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner