Provider Demographics
NPI:1326469164
Name:KUEHL, BRENDA LOUISE
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LOUISE
Last Name:KUEHL
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 1:1211 HAWAII AVE
Mailing Address - Street 2:P O BOX 650
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6437
Mailing Address - Country:US
Mailing Address - Phone:575-812-5994
Mailing Address - Fax:575-812-5999
Practice Address - Street 1:805 12TH ST BLDG B
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6434
Practice Address - Country:US
Practice Address - Phone:575-812-5970
Practice Address - Fax:575-812-5999
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist