Provider Demographics
NPI:1407269236
Name:BRENDEL, KELLY L (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:BRENDEL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W571 COUNTY ROAD L
Mailing Address - Street 2:
Mailing Address - City:EAST TROY
Mailing Address - State:WI
Mailing Address - Zip Code:53120-2408
Mailing Address - Country:US
Mailing Address - Phone:815-222-1641
Mailing Address - Fax:
Practice Address - Street 1:W571 COUNTY ROAD L
Practice Address - Street 2:
Practice Address - City:EAST TROY
Practice Address - State:WI
Practice Address - Zip Code:53120-2408
Practice Address - Country:US
Practice Address - Phone:815-222-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5946363LF0000X
WI19854730363L00000X
IL209-011771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400208395Medicare PIN