Provider Demographics
NPI:1083972970
Name:ENO, BRENDA ENEKE (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ENEKE
Last Name:ENO
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9332 ANNAPOLIS RD.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:240-643-4430
Mailing Address - Fax:202-503-2363
Practice Address - Street 1:9332 ANNAPOLIS RD # SUITE 105
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:301-708-9309
Practice Address - Fax:800-348-2155
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1016390363LP0808X
376K00000X
MDR178470363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No376K00000XNursing Service Related ProvidersNurse's Aide