Provider Demographics
NPI:1033985262
Name:WHITEHEAD, BRENDA FRANCES
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:FRANCES
Last Name:WHITEHEAD
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 1:10233 BLUE RIDGE DR S
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9059
Mailing Address - Country:US
Mailing Address - Phone:419-376-4451
Mailing Address - Fax:
Practice Address - Street 1:3680 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:RISINGSUN
Practice Address - State:OH
Practice Address - Zip Code:43457-9721
Practice Address - Country:US
Practice Address - Phone:419-376-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker