Provider Demographics
NPI:1780855882
Name:WHITE, BRENDA (RN, IBCLC, CCE)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN, IBCLC, CCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12530 FAIRWOOD PKWY
Mailing Address - Street 2:SUITE 101-14
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6356
Mailing Address - Country:US
Mailing Address - Phone:301-336-4726
Mailing Address - Fax:
Practice Address - Street 1:1502 BAYTREE TER
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-2384
Practice Address - Country:US
Practice Address - Phone:301-336-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD199-16122163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant