Provider Demographics
NPI:1982775755
Name:CHENEY, BRENDA P (NP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:P
Last Name:CHENEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LEIGH
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:3 DORSET CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3177
Mailing Address - Country:US
Mailing Address - Phone:912-898-1171
Mailing Address - Fax:
Practice Address - Street 1:1139 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5502
Practice Address - Country:US
Practice Address - Phone:912-303-4200
Practice Address - Fax:912-790-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN127960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBGQZMedicare ID - Type Unspecified
GAP85297Medicare UPIN