Provider Demographics
NPI:1992951255
Name:TERNEY, BRENDA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:TERNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 HORSEBLOCK RD
Mailing Address - Street 2:APT 2B
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-5101
Mailing Address - Country:US
Mailing Address - Phone:631-981-1535
Mailing Address - Fax:
Practice Address - Street 1:58 HORSEBLOCK RD
Practice Address - Street 2:APT 2B
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-5101
Practice Address - Country:US
Practice Address - Phone:631-981-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237712164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse