Provider Demographics
NPI:1407361405
Name:FRANCIS, BRENDA GAIL (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:GAIL
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 BADGER CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-2109
Mailing Address - Country:US
Mailing Address - Phone:920-296-5104
Mailing Address - Fax:
Practice Address - Street 1:950 BADGER CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-2109
Practice Address - Country:US
Practice Address - Phone:920-296-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI125780163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse