Provider Demographics
NPI:1891769949
Name:RODI, BRENDA F (FNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:F
Last Name:RODI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 N MASON RD STE 160
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6387
Mailing Address - Country:US
Mailing Address - Phone:314-996-3434
Mailing Address - Fax:314-996-3435
Practice Address - Street 1:969 N MASON RD STE 160
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6387
Practice Address - Country:US
Practice Address - Phone:314-996-3434
Practice Address - Fax:314-996-3435
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN564299363L00000X
MO2019002282363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN564299Medicaid
CARN564299Medicaid
CAQ18701Medicare UPIN