Provider Demographics
NPI:1962713545
Name:PFIZENMAIER, BRENDA LYNN (MS,RD,LD, CPT, CDE)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LYNN
Last Name:PFIZENMAIER
Suffix:
Gender:F
Credentials:MS,RD,LD, CPT, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 LOUISIANA RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-8989
Mailing Address - Country:US
Mailing Address - Phone:785-229-8458
Mailing Address - Fax:785-229-8344
Practice Address - Street 1:1301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3537
Practice Address - Country:US
Practice Address - Phone:785-229-8458
Practice Address - Fax:785-229-8344
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS890133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered