Provider Demographics
NPI:1831279595
Name:ROSENTHAL, BRENDA J (ARNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:J
Other - Last Name:FOGELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12140 NALL AVE
Mailing Address - Street 2:STE 305
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209
Mailing Address - Country:US
Mailing Address - Phone:913-948-6400
Mailing Address - Fax:913-438-2128
Practice Address - Street 1:5701 W 119TH STREET
Practice Address - Street 2:STE 345
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209
Practice Address - Country:US
Practice Address - Phone:913-888-5577
Practice Address - Fax:913-438-2128
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45811363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
M79E828OtherPROVIDER #