Provider Demographics
NPI:1619499860
Name:RADERMACHER, BRENNA LEIGH (DNP, APRN, AGNP-C)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:LEIGH
Last Name:RADERMACHER
Suffix:
Gender:F
Credentials:DNP, APRN, AGNP-C
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:LEIGH
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:1425 HAMPSHIRE AVE S APT 323
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2163
Mailing Address - Country:US
Mailing Address - Phone:507-995-0654
Mailing Address - Fax:
Practice Address - Street 1:500 HARVARD ST SE UNIT 7D
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0363
Practice Address - Country:US
Practice Address - Phone:612-273-3074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2085531163W00000X
MN5247363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse