Provider Demographics
NPI:1912787755
Name:HOOPER, BRENDA L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:HOOPER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1508
Mailing Address - Country:US
Mailing Address - Phone:203-918-4837
Mailing Address - Fax:
Practice Address - Street 1:82 BOXWOOD DR
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-1508
Practice Address - Country:US
Practice Address - Phone:203-918-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTAG08230087363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology