Provider Demographics
NPI:1891927091
Name:GRAVESANDE, BRENDA E (RN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:E
Last Name:GRAVESANDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1402
Mailing Address - Country:US
Mailing Address - Phone:239-513-7400
Mailing Address - Fax:239-513-7435
Practice Address - Street 1:1665 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1402
Practice Address - Country:US
Practice Address - Phone:239-513-7400
Practice Address - Fax:239-513-7435
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2675102171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator