Provider Demographics
NPI:1295708634
Name:ABERCROMBIE, BRENDA L (FNP, CNM)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:ABERCROMBIE
Suffix:
Gender:F
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12329 S HIGHWAY 39
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:MO
Mailing Address - Zip Code:65785-8580
Mailing Address - Country:US
Mailing Address - Phone:417-276-4663
Mailing Address - Fax:636-600-5260
Practice Address - Street 1:12329 S HIGHWAY 39
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785-8580
Practice Address - Country:US
Practice Address - Phone:417-276-4663
Practice Address - Fax:636-600-5260
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO129233163WG0000X
MO129223363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1521024Medicare PIN
MOX93000040Medicare PIN