Provider Demographics
NPI:1740053867
Name:BROWN, BRENDA LOUISE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOUISE
Last Name:BROWN
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 1:480 COUNTY ROAD 651
Mailing Address - Street 2:
Mailing Address - City:HANCEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35077-6428
Mailing Address - Country:US
Mailing Address - Phone:256-887-3210
Mailing Address - Fax:
Practice Address - Street 1:101 JUDY SMITH DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-4501
Practice Address - Country:US
Practice Address - Phone:256-582-4033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-172087163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse