Provider Demographics
NPI:1366068827
Name:BRONDSTETTER, THERESA INA (NP-C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:INA
Last Name:BRONDSTETTER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:RM H0101, MC 5623
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5623
Mailing Address - Country:US
Mailing Address - Phone:650-723-0822
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:RM H0101, MC 5623
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5623
Practice Address - Country:US
Practice Address - Phone:650-723-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-21
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95013947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner