Provider Demographics
NPI:1811211014
Name:HANCOCK, BRENDA A (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:A
Other - Last Name:LYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:659 WESTFIELD WAY
Mailing Address - Street 2:UNIT F
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6585
Mailing Address - Country:US
Mailing Address - Phone:262-617-9919
Mailing Address - Fax:
Practice Address - Street 1:659 WESTFIELD WAY
Practice Address - Street 2:UNIT F
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6585
Practice Address - Country:US
Practice Address - Phone:262-617-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI96064-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse