Provider Demographics
NPI:1114979564
Name:ALBERTZ, BRENDA LEE (RN FNP)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:ALBERTZ
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:ALBERTZ-CROCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN FNP
Mailing Address - Street 1:1600 9TH STREET
Mailing Address - Street 2:ROOM 205 MAILSTOP 2-3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-6414
Mailing Address - Country:US
Mailing Address - Phone:916-654-2431
Mailing Address - Fax:916-654-3186
Practice Address - Street 1:15000 ARNOLD DRIVE
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95431-1493
Practice Address - Country:US
Practice Address - Phone:707-938-6556
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6750363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S67269Medicare UPIN