Provider Demographics
NPI:1376375824
Name:WHITENER, BRANDIE MERRIE (LPN)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:MERRIE
Last Name:WHITENER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E HAWTHORNE ST APT 8
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-3148
Mailing Address - Country:US
Mailing Address - Phone:706-218-0116
Mailing Address - Fax:
Practice Address - Street 1:409 E HAWTHORNE ST APT 8
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-3148
Practice Address - Country:US
Practice Address - Phone:706-218-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN090641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse