Provider Demographics
NPI:1316436173
Name:BREDENBERG, MILDRED LEE (LAC)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:LEE
Last Name:BREDENBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:BREDENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:52 MILDRED AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3116
Mailing Address - Country:US
Mailing Address - Phone:828-785-2934
Mailing Address - Fax:
Practice Address - Street 1:551 BURMA RD W
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5583
Practice Address - Country:US
Practice Address - Phone:828-785-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC642171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty