Provider Demographics
NPI:1740845148
Name:DUSHEK, BRENDA KAY (OPA-C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:DUSHEK
Suffix:
Gender:F
Credentials:OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MEDICAL CAMPUS DR NW STE 104
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4094
Mailing Address - Country:US
Mailing Address - Phone:910-575-5800
Mailing Address - Fax:
Practice Address - Street 1:20 MEDICAL CAMPUS DR NW STE 104
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4094
Practice Address - Country:US
Practice Address - Phone:910-575-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1305363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical