Provider Demographics
NPI:1801405212
Name:MILLER, BRENDA SUE (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:SUE
Other - Last Name:TOBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8320 OLD COURTHOUSE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3848
Mailing Address - Country:US
Mailing Address - Phone:703-226-4000
Mailing Address - Fax:703-226-4010
Practice Address - Street 1:8320 OLD COURTHOUSE RD STE 400
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3848
Practice Address - Country:US
Practice Address - Phone:703-226-4000
Practice Address - Fax:703-226-4010
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001245334163WN0800X
VA0024180418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience