Provider Demographics
NPI:1487225405
Name:FONDER, BRENDA LEE (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:FONDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:KURTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6410 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:WI
Mailing Address - Zip Code:54139-9188
Mailing Address - Country:US
Mailing Address - Phone:920-604-3023
Mailing Address - Fax:
Practice Address - Street 1:6410 MILITARY RD
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:WI
Practice Address - Zip Code:54139-9188
Practice Address - Country:US
Practice Address - Phone:920-604-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI116995-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse