Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN225409 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN225409 | GA |
NPI | 1083015531 |
---|---|
Provider Name | Brenda W. Mccurdy |
First Address | Lake Park, GA 31636-1342 |
Second Address | Cordele, GA 31015-3422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2014 |
Last Update Date | 15/09/2014 |