Provider Demographics
NPI:1093302994
Name:DURHAM, BRENDA K
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:DURHAM
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 1:2190 STATE ROUTE 286
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-9314
Mailing Address - Country:US
Mailing Address - Phone:513-646-0061
Mailing Address - Fax:
Practice Address - Street 1:2190 STATE ROUTE 286
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-9314
Practice Address - Country:US
Practice Address - Phone:513-646-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-25
Last Update Date:2020-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker