Provider Demographics
NPI:1215320940
Name:HUSEMANN, BRENDA ANN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:ANN
Last Name:HUSEMANN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:ANN
Other - Last Name:HAMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18491 W MICHELLE CT
Mailing Address - Street 2:
Mailing Address - City:EAST DUBUQUE
Mailing Address - State:IL
Mailing Address - Zip Code:61025-9403
Mailing Address - Country:US
Mailing Address - Phone:563-213-1576
Mailing Address - Fax:
Practice Address - Street 1:18491 W MICHELLE CT
Practice Address - Street 2:
Practice Address - City:EAST DUBUQUE
Practice Address - State:IL
Practice Address - Zip Code:61025-9403
Practice Address - Country:US
Practice Address - Phone:563-213-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA107305363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care