Provider Demographics
NPI:1669146999
Name:LIPSCOMB, BRENDA GRAHAM
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:GRAHAM
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PENNYGENT LN
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4559
Mailing Address - Country:US
Mailing Address - Phone:832-472-1388
Mailing Address - Fax:
Practice Address - Street 1:1111 PENNYGENT LN
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4559
Practice Address - Country:US
Practice Address - Phone:832-472-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider