Basic Information
| Provider Information | |||||||||
| NPI: | 1801088505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENRIGHT | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19009 SUGAR LAKE TRL | ||||||||
| Address2: | |||||||||
| City: | COHASSET | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557218950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183265000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1601 GOLF COURSE RD | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557448648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183265000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2007 | ||||||||
| LastUpdateDate: | 03/17/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704133894 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | R192321-2 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | R192323-2 | 01 | MN | MN REGISTERED NURSE LICENSE | OTHER | 4704133894 | 01 | MI | MICHIGAN STATE LICENSE # | OTHER |