Provider Demographics
NPI:1356591564
Name:DRIMMEL, BRENDA LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEE
Last Name:DRIMMEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:STEADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:12325 4TH CT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-1989
Mailing Address - Country:US
Mailing Address - Phone:612-701-2284
Mailing Address - Fax:763-533-1607
Practice Address - Street 1:4124 QUEBEC AVE N STE 305
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55427-1241
Practice Address - Country:US
Practice Address - Phone:763-533-1919
Practice Address - Fax:763-533-1607
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR129579-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA486245700Medicaid