Provider Demographics
NPI:1518717784
Name:STOPSEN, BRENDA RENE (RNFA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:RENE
Last Name:STOPSEN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:RENE
Other - Last Name:EVENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-5011
Mailing Address - Country:US
Mailing Address - Phone:360-590-2311
Mailing Address - Fax:
Practice Address - Street 1:1000 STATE ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-3704
Practice Address - Country:US
Practice Address - Phone:208-630-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID61591163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant