Provider Demographics
NPI:1932268067
Name:BRENDEMUEHL, JUDITH (MD0)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:BRENDEMUEHL
Suffix:
Gender:F
Credentials:MD0
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 STOLLINGS AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-4035
Mailing Address - Country:US
Mailing Address - Phone:304-752-2770
Mailing Address - Fax:304-752-2772
Practice Address - Street 1:140 STOLLINGS AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-4035
Practice Address - Country:US
Practice Address - Phone:304-752-2770
Practice Address - Fax:304-752-2772
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist