Provider Demographics
NPI:1528299641
Name:PICKHARDT, BRENDA A (CNM)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:A
Last Name:PICKHARDT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MONTCALM ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-1321
Mailing Address - Country:US
Mailing Address - Phone:315-343-2590
Mailing Address - Fax:315-343-4197
Practice Address - Street 1:1108 E MULBERRY ST
Practice Address - Street 2:STE A
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3955
Practice Address - Country:US
Practice Address - Phone:409-266-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120367367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife