Provider Demographics
NPI:1972529881
Name:HARPER, BRENDA LIN (LVN)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LIN
Last Name:HARPER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:LIN
Other - Last Name:JORGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7915 PAWNEE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-2133
Mailing Address - Country:US
Mailing Address - Phone:916-874-2554
Mailing Address - Fax:916-874-9297
Practice Address - Street 1:4600 BROADWAY
Practice Address - Street 2:STE 1100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1527
Practice Address - Country:US
Practice Address - Phone:916-874-9670
Practice Address - Fax:916-874-9297
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 216644164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse