Provider Demographics
NPI:1972556751
Name:PATRICK, BRENDA FAYE (NP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:FAYE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13851 E 14TH ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2631
Mailing Address - Country:US
Mailing Address - Phone:510-351-9373
Mailing Address - Fax:510-351-7026
Practice Address - Street 1:13851 E 14TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2631
Practice Address - Country:US
Practice Address - Phone:510-351-9373
Practice Address - Fax:510-351-7026
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA271955363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA271955OtherCALIFORNIA BOARD OF RN