1568519593 NPI number — MS. BRENDA J POPE RN, MSN, FNP-BC

Table of content: MS. BRENDA J POPE RN, MSN, FNP-BC (NPI 1568519593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568519593 NPI number — MS. BRENDA J POPE RN, MSN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POPE
Provider First Name:
BRENDA
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568519593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 FRANK LLOYD WRIGHT DRIVE
Provider Second Line Business Mailing Address:
SUITE J2000
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-674-9300
Provider Business Mailing Address Fax Number:
248-674-9309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
IHA WATERFORD PRIMARY CARE
Provider Second Line Business Practice Location Address:
4400 HIGHLAND RD, SUITE 100
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-618-6000
Provider Business Practice Location Address Fax Number:
248-618-6951
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  4704167009 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500F337710 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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