Provider Demographics
NPI:1548709918
Name:CHURCHMAN, BRENDA KAY (APRN)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KAY
Last Name:CHURCHMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:LOYALTON
Mailing Address - State:CA
Mailing Address - Zip Code:96118-0522
Mailing Address - Country:US
Mailing Address - Phone:530-559-3112
Mailing Address - Fax:
Practice Address - Street 1:280 VISTA KNOLL PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-5647
Practice Address - Country:US
Practice Address - Phone:775-770-7530
Practice Address - Fax:775-770-7540
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-18
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily