Provider Demographics
NPI:1720055031
Name:BRENGARD, MARLENE (APN)
Entity type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:
Last Name:BRENGARD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 HILL HOME DR
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4019
Mailing Address - Country:US
Mailing Address - Phone:870-239-9955
Mailing Address - Fax:870-239-2306
Practice Address - Street 1:300 CARSON ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3104
Practice Address - Country:US
Practice Address - Phone:870-932-5296
Practice Address - Fax:870-910-7713
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSO1120CNS364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Z002Medicare PIN