Individual
MISS BRENDA M KENDUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7860 SW 204TH AVE, DUNNELLON, FL 34431-5169
(352) 362-8074
(352) 465-3243
Mailing address
7860 SW 204TH AVE, DUNNELLON, FL 34431-5169
(352) 362-8074
(352) 465-3243
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
679111596
—
FL
Enumeration date
01/05/2011
Last updated
01/05/2011
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