Provider Demographics
NPI:1942934310
Name:MOGERE, BRENDA (REGISTERED NURSE RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MOGERE
Suffix:
Gender:F
Credentials:REGISTERED NURSE RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3057 N YALE WAY
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-8573
Mailing Address - Country:US
Mailing Address - Phone:302-252-5636
Mailing Address - Fax:
Practice Address - Street 1:3057 N YALE WAY
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-8573
Practice Address - Country:US
Practice Address - Phone:302-252-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95109508163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical