Provider Demographics
NPI:1750953477
Name:BRENDAMOUR, BRYN LOU (MSN, APN, FNP-C)
Entity type:Individual
Prefix:
First Name:BRYN
Middle Name:LOU
Last Name:BRENDAMOUR
Suffix:
Gender:F
Credentials:MSN, APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 S GALENA ST UNIT 440
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1872
Mailing Address - Country:US
Mailing Address - Phone:513-314-4868
Mailing Address - Fax:
Practice Address - Street 1:123 EMMA RD
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-9169
Practice Address - Country:US
Practice Address - Phone:970-945-2840
Practice Address - Fax:970-945-2893
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996610-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily