Provider Demographics
NPI:1003455403
Name:LANSDEN, BRENNA (MSN,FNP-C,IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:
Last Name:LANSDEN
Suffix:
Gender:F
Credentials:MSN,FNP-C,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 CHEAT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4210
Mailing Address - Country:US
Mailing Address - Phone:304-594-2481
Mailing Address - Fax:
Practice Address - Street 1:608 CHEAT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4210
Practice Address - Country:US
Practice Address - Phone:304-594-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVL-160867163WL0100X
WV117113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant