Provider Demographics
NPI:1962654491
Name:WHITTENBURG-CHOATE, BRENDA LOU (RN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOU
Last Name:WHITTENBURG-CHOATE
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 1:817 MORNINGSIDE DR
Mailing Address - Street 2:2
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3776
Mailing Address - Country:US
Mailing Address - Phone:423-943-2669
Mailing Address - Fax:
Practice Address - Street 1:10810 PARKSIDE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1979
Practice Address - Country:US
Practice Address - Phone:865-218-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000064890163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse