Provider Demographics
NPI:1477371482
Name:AYENSU, BRENDA O
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:O
Last Name:AYENSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9692 NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1883
Mailing Address - Country:US
Mailing Address - Phone:240-565-9796
Mailing Address - Fax:
Practice Address - Street 1:9692 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1883
Practice Address - Country:US
Practice Address - Phone:240-565-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR244751163W00000X, 163WA2000X, 163WD0400X, 163WG0600X, 163WH0200X, 163WP0000X, 163WP2201X, 364S00000X, 163WC2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist