Provider Demographics
NPI:1497415616
Name:WHITE, BRENDA FAYE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:FAYE
Last Name:WHITE
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 1:409 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1036
Mailing Address - Country:US
Mailing Address - Phone:304-538-7624
Mailing Address - Fax:
Practice Address - Street 1:409 SPRING AVE
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1036
Practice Address - Country:US
Practice Address - Phone:304-538-7624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant