1083972970 NPI number — BRENDA ENEKE ENO CRNP-PMH

Table of content: DANIEL LEWIS SPITZ M.D. (NPI 1134125214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083972970 NPI number — BRENDA ENEKE ENO CRNP-PMH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENO
Provider First Name:
BRENDA
Provider Middle Name:
ENEKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP-PMH
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:
1083972970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9332 ANNAPOLIS RD.
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
LANHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-643-4430
Provider Business Mailing Address Fax Number:
202-503-2363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9332 ANNAPOLIS RD # SUITE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-708-9309
Provider Business Practice Location Address Fax Number:
800-348-2155
Provider Enumeration Date:
04/27/2012

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: 363LP0808X , with the licence number:  RN1016390 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: R178470 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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