Provider Demographics
NPI:1053919209
Name:FICEK, BRENDA MARIE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:FICEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 23RD ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2726
Mailing Address - Country:US
Mailing Address - Phone:701-590-0695
Mailing Address - Fax:
Practice Address - Street 1:769 23RD ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2726
Practice Address - Country:US
Practice Address - Phone:701-590-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-10
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant