Provider Demographics
NPI:1578535639
Name:OBERHELMAN, BRENDA S (CFNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:OBERHELMAN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3905
Mailing Address - Country:US
Mailing Address - Phone:515-574-6890
Mailing Address - Fax:515-574-6112
Practice Address - Street 1:800 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5776
Practice Address - Country:US
Practice Address - Phone:515-574-6800
Practice Address - Fax:515-574-6816
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA068306363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0456053Medicaid
IA500012313OtherRR MEDICARE
IA10210OtherBC/BS
IA10210OtherBC/BS
IAQ35838Medicare UPIN