Provider Demographics
NPI:1619552494
Name:LINGHAM, BRENDA D (NP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:D
Last Name:LINGHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:PINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-6548
Mailing Address - Country:US
Mailing Address - Phone:856-816-4251
Mailing Address - Fax:
Practice Address - Street 1:149 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:PINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:08021-6548
Practice Address - Country:US
Practice Address - Phone:856-816-4251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01088800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health