Provider Demographics
NPI:1346453586
Name:STEPHENS, BRENDA LEE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:438 N FREDERICK AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2458
Mailing Address - Country:US
Mailing Address - Phone:240-631-0200
Mailing Address - Fax:240-631-0300
Practice Address - Street 1:438 N FREDERICK AVE STE 320
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2458
Practice Address - Country:US
Practice Address - Phone:240-631-0200
Practice Address - Fax:240-631-0300
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR151109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily