Brenda Lee Fonder, RN
Individual provider Active NPI Registered Nurse · Lena, WI
NPI 1487225405 · NPPES record last updated Jul 9, 2021
Key facts
- NPI
- 1487225405
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 116995-30 (WI)
- Practice address
- 6410 Military Rd
Lena, WI 54139-9188 - Phone
- (920) 604-3023
- NPI assigned
- Jul 9, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116995-30 | WI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 116995-30 | WI | Yes |
Addresses
Primary practice location
6410 Military Rd
Lena, WI 54139-9188
Mailing address
6410 Military Rd
Lena, WI 54139-9188
Phone (920) 604-3023
Other names
- Brenda Lee Kurth
Other providers in Lena, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.