Provider Demographics
NPI:1821363110
Name:WHITE, BRENDA M (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 BRUCKNER BLVD
Mailing Address - Street 2:APT 10E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1943
Mailing Address - Country:US
Mailing Address - Phone:718-824-7816
Mailing Address - Fax:
Practice Address - Street 1:1932 ARTHUR AVE
Practice Address - Street 2:ROOM403B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6306
Practice Address - Country:US
Practice Address - Phone:718-579-6853
Practice Address - Fax:718-579-6883
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY346360163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse