Provider Demographics
NPI:1477501096
Name:DANIELS, BRENDA J (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:DANIELS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 EVANS ST
Mailing Address - Street 2:SUITE 104 - A1
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5301
Mailing Address - Country:US
Mailing Address - Phone:252-830-9222
Mailing Address - Fax:252-756-4220
Practice Address - Street 1:1530 EVANS ST
Practice Address - Street 2:SUITE 104 - A1
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5301
Practice Address - Country:US
Practice Address - Phone:252-830-9222
Practice Address - Fax:252-756-4220
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC109310163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7100352Medicaid
NC7702971Medicaid
NC6600741Medicaid
NC7702971Medicaid