Provider Demographics
NPI:1063823029
Name:BOTCHWAY, BRENDA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BOTCHWAY
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 1:981 ROLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-5615
Mailing Address - Country:US
Mailing Address - Phone:240-777-3325
Mailing Address - Fax:240-777-3304
Practice Address - Street 1:981 ROLLINS AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-5615
Practice Address - Country:US
Practice Address - Phone:240-777-3325
Practice Address - Fax:240-777-3304
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR073937163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)