Provider Demographics
NPI:1942520952
Name:NISHIZAWA, BRENDA NICOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:NICOLE
Last Name:NISHIZAWA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5249 E TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-8339
Mailing Address - Country:US
Mailing Address - Phone:608-222-9777
Mailing Address - Fax:608-441-3985
Practice Address - Street 1:5249 E TERRACE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-8339
Practice Address - Country:US
Practice Address - Phone:608-222-9777
Practice Address - Fax:608-441-3985
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71525-21207R00000X
MI5101018745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine