Provider Demographics
NPI:1972068716
Name:MUHOMA, BRENDA (DNP, FNP, RN)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:MUHOMA
Suffix:
Gender:F
Credentials:DNP, FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 LOUISA LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6187
Mailing Address - Country:US
Mailing Address - Phone:209-225-5620
Mailing Address - Fax:
Practice Address - Street 1:842 LOUISA LN
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6187
Practice Address - Country:US
Practice Address - Phone:209-225-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN263300163W00000X
NY353529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse