Provider Demographics
NPI:1285742403
Name:MEDLEY, BRENDA DONATTO (NP)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:DONATTO
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6760 CURRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-1720
Mailing Address - Country:US
Mailing Address - Phone:504-495-1384
Mailing Address - Fax:
Practice Address - Street 1:6760 CURRAN BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-1720
Practice Address - Country:US
Practice Address - Phone:504-495-1384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1285742403OtherNPI
LA1101109Medicaid