Basic Information
Provider Information | |||||||||
NPI: | 1770627960 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HOLBERT-FERNANDEZ | ||||||||
FirstName: | BRENDA | ||||||||
MiddleName: | LOUISE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NURSE PRACTITIONER | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1201 W FRANK AVE | ||||||||
Address2: | TEMPLE CANCER CENTER | ||||||||
City: | LUFKIN | ||||||||
State: | TX | ||||||||
PostalCode: | 759043357 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9366397466 | ||||||||
FaxNumber: | 9366397472 | ||||||||
Practice Location | |||||||||
Address1: | 1201 W FRANK AVE | ||||||||
Address2: | TEMPLE CANCER CENTER | ||||||||
City: | LUFKIN | ||||||||
State: | TX | ||||||||
PostalCode: | 759043357 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9366397466 | ||||||||
FaxNumber: | 9366397472 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/19/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 581785 | TX | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.