Provider Demographics
NPI:1508126897
Name:BRENDEL, YOOMI KENYON (APN, NP-C)
Entity Type:Individual
Prefix:
First Name:YOOMI
Middle Name:KENYON
Last Name:BRENDEL
Suffix:
Gender:F
Credentials:APN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 DELNOR DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4220
Mailing Address - Country:US
Mailing Address - Phone:630-933-5518
Mailing Address - Fax:630-933-4168
Practice Address - Street 1:351 DELNOR DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4220
Practice Address - Country:US
Practice Address - Phone:630-933-5518
Practice Address - Fax:630-933-4168
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009499363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
ILCA4748OtherRR MEDICARE PTAN (GROUP)
ILP01098970OtherRR MEDICARE PTAN (INDIVIDUAL)
IL206147124OtherMEDICARE PTAN (INDIVIDUAL)
IL$$$$$$$$$001Medicaid