Provider Demographics
NPI:1912415407
Name:BRENDER, DEBRA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BRENDER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17270 CLARA ST
Mailing Address - Street 2:
Mailing Address - City:MONTE SERENO
Mailing Address - State:CA
Mailing Address - Zip Code:95030-2266
Mailing Address - Country:US
Mailing Address - Phone:408-250-9773
Mailing Address - Fax:
Practice Address - Street 1:17270 CLARA ST
Practice Address - Street 2:
Practice Address - City:MONTE SERENO
Practice Address - State:CA
Practice Address - Zip Code:95030-2266
Practice Address - Country:US
Practice Address - Phone:408-250-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN454898163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant