Provider Demographics
NPI:1639830805
Name:BRATTON, BRENDA WILLIAMS (LPN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:WILLIAMS
Last Name:BRATTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6681 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6481
Mailing Address - Country:US
Mailing Address - Phone:704-840-5179
Mailing Address - Fax:
Practice Address - Street 1:6681 WISTERIA DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6481
Practice Address - Country:US
Practice Address - Phone:704-840-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD50522164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse