Provider Demographics
NPI:1407192487
Name:CARTER, BRENDA VALENCIA
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:VALENCIA
Last Name:CARTER
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 1:2900 LEGIONARY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-6548
Mailing Address - Country:US
Mailing Address - Phone:614-492-8217
Mailing Address - Fax:
Practice Address - Street 1:2900 LEGIONARY ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-6548
Practice Address - Country:US
Practice Address - Phone:614-492-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.414952163W00000X
OHM-IV PN.149574164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse