Provider Demographics
NPI:1366403693
Name:PATZEL, BRENDA JOYCE (PHD, APRN,)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOYCE
Last Name:PATZEL
Suffix:
Gender:F
Credentials:PHD, APRN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 WEST 6TH SUITE C
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-273-2252
Mailing Address - Fax:
Practice Address - Street 1:2619 WEST 6TH SUITE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-830-8299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-39922-111163W00000X
KS74211363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
R76328Medicare UPIN
KS161492Medicare ID - Type Unspecified