Provider Demographics
NPI:1669669594
Name:BRENDA WINDEMUTH CRNP LLC
Entity Type:Organization
Organization Name:BRENDA WINDEMUTH CRNP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:WINDEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-546-8224
Mailing Address - Street 1:3580 REDDEN FERRY RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:MD
Mailing Address - Zip Code:21822-2232
Mailing Address - Country:US
Mailing Address - Phone:410-546-8224
Mailing Address - Fax:410-546-8224
Practice Address - Street 1:3580 REDDEN FERRY RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:MD
Practice Address - Zip Code:21822-2232
Practice Address - Country:US
Practice Address - Phone:410-546-8224
Practice Address - Fax:410-546-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS82978Medicare UPIN