Provider Demographics
NPI:1841358918
Name:PAWL, BRENDA LEE (MSN, APRN, B)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEE
Last Name:PAWL
Suffix:
Gender:F
Credentials:MSN, APRN, B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 FULTON ST E STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3211
Mailing Address - Country:US
Mailing Address - Phone:616-726-2455
Mailing Address - Fax:616-726-2456
Practice Address - Street 1:214 FULTON ST E STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3211
Practice Address - Country:US
Practice Address - Phone:616-726-2455
Practice Address - Fax:616-726-2456
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL810467363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner