Provider Demographics
NPI:1164108171
Name:MARQUARD, BRENDA LEE (LPN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:MARQUARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-9103
Mailing Address - Country:US
Mailing Address - Phone:920-960-0381
Mailing Address - Fax:
Practice Address - Street 1:809 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-9103
Practice Address - Country:US
Practice Address - Phone:920-960-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI307487-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse