Provider Demographics
NPI:1982655536
Name:RAWSON, BRENDA R (NNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:R
Last Name:RAWSON
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:R
Other - Last Name:VANDERPOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NNP
Mailing Address - Street 1:5900 BYRON CENTER AVE SW
Mailing Address - Street 2:MEDICAL ADMINISTRATION
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9606
Mailing Address - Country:US
Mailing Address - Phone:616-252-3243
Mailing Address - Fax:616-252-0260
Practice Address - Street 1:5900 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9606
Practice Address - Country:US
Practice Address - Phone:616-252-7184
Practice Address - Fax:616-252-6218
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN161098-1363LN0000X
MI4704146251363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal