Provider Demographics
NPI:1124199955
Name:BARTELS, BRENDA ANN (GERIATRIC NP PRESCRI)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ANN
Last Name:BARTELS
Suffix:
Gender:F
Credentials:GERIATRIC NP PRESCRI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 W RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3452
Mailing Address - Country:US
Mailing Address - Phone:866-480-9927
Mailing Address - Fax:414-443-4818
Practice Address - Street 1:10701 W RESEARCH DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3452
Practice Address - Country:US
Practice Address - Phone:866-480-9927
Practice Address - Fax:414-443-4818
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1016033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43939700Medicaid
WI43939700Medicaid