Provider Demographics
NPI:1568935880
Name:LANDRY, BRENDA (LNA, OWNER)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LNA, OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-1132
Mailing Address - Country:US
Mailing Address - Phone:603-210-3047
Mailing Address - Fax:
Practice Address - Street 1:15 PINE ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NH
Practice Address - Zip Code:03275-1132
Practice Address - Country:US
Practice Address - Phone:603-210-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH015305-24374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide