Provider Demographics
NPI:1205946977
Name:POLAND, BRENDA SUE (NPC)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:SUE
Last Name:POLAND
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:SUE
Other - Last Name:SEIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3434 W ST JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917
Mailing Address - Country:US
Mailing Address - Phone:517-372-2045
Mailing Address - Fax:
Practice Address - Street 1:405 W GREENLAWN AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-485-8217
Practice Address - Fax:517-485-3871
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704207280363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner