Provider Demographics
NPI:1669179818
Name:RODGERS, BRENDA LYNN
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LYNN
Last Name:RODGERS
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 1:15205 SPRING BROOK TER
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-5657
Mailing Address - Country:US
Mailing Address - Phone:952-388-9240
Mailing Address - Fax:
Practice Address - Street 1:15205 SPRING BROOK TER
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-5657
Practice Address - Country:US
Practice Address - Phone:952-388-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN408235376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker