Provider Demographics
NPI:1457444283
Name:PRICE, BRENDA SHORTER (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:SHORTER
Last Name:PRICE
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3030 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2217
Mailing Address - Country:US
Mailing Address - Phone:610-622-7933
Mailing Address - Fax:610-622-7937
Practice Address - Street 1:3030 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2217
Practice Address - Country:US
Practice Address - Phone:610-622-7933
Practice Address - Fax:610-622-7937
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008581363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100386Medicare PIN
Q67925Medicare UPIN