Provider Demographics
NPI:1689441982
Name:FLUHARTY, BRENDA NICOLE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:NICOLE
Last Name:FLUHARTY
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 1:1108 RAIL RD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26571
Mailing Address - Country:US
Mailing Address - Phone:681-332-6681
Mailing Address - Fax:
Practice Address - Street 1:1108 RAIL RD ST APT 3
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:WV
Practice Address - Zip Code:26571
Practice Address - Country:US
Practice Address - Phone:681-332-6681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant