1083972970 NPI number — BRENDA ENEKE ENO CRNP-PMH

Table of content: BRENDA ENEKE ENO CRNP-PMH (NPI 1083972970)

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)