Provider Demographics
NPI:1912194895
Name:LANDAU, BRENDA K (NP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:LANDAU
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-2050
Mailing Address - Fax:704-316-2051
Practice Address - Street 1:16525 HOLLY CREST LN STE 150
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4911
Practice Address - Country:US
Practice Address - Phone:704-384-8720
Practice Address - Fax:704-384-8747
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-03522363LF0000X
NC5003522363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005483Medicaid
NC7005483Medicaid