Provider Demographics
NPI:1164170627
Name:TORAIN, BRENDA JOHNSON
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOHNSON
Last Name:TORAIN
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 1:200 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-2770
Mailing Address - Country:US
Mailing Address - Phone:336-327-2507
Mailing Address - Fax:
Practice Address - Street 1:487 NORTH WASHINGTON AVENUE
Practice Address - Street 2:487 NORTH WASHINGTON AVE
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320
Practice Address - Country:US
Practice Address - Phone:336-327-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide