Provider Demographics
NPI:1588331771
Name:MCDONNELL, BRENDA JEAN (AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JEAN
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CIMMARRON VISTA CT
Mailing Address - Street 2:
Mailing Address - City:RUNAWAY BAY
Mailing Address - State:TX
Mailing Address - Zip Code:76426-9726
Mailing Address - Country:US
Mailing Address - Phone:412-908-3884
Mailing Address - Fax:
Practice Address - Street 1:204 CIMMARRON VISTA CT
Practice Address - Street 2:
Practice Address - City:RUNAWAY BAY
Practice Address - State:TX
Practice Address - Zip Code:76426-9726
Practice Address - Country:US
Practice Address - Phone:412-908-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022615363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner