Individual
MRS. BRENDA RENEE MORTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
121 MAPLE ST, EDGERTON, WI 53534-9332
(608) 884-3999
Mailing address
121 MAPLE ST, EDGERTON, WI 53534-9332
(608) 884-3999
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
189634-30
WI
163WH0200X
Home Health Registered Nurse
189634-30
WI
Other
Enumeration date
07/13/2012
Last updated
07/13/2012
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