Provider Demographics
NPI:1306595137
Name:HARRIS, BRENDA ANNE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANNE
Last Name:HARRIS
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 1:6101 WALDERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3415
Mailing Address - Country:US
Mailing Address - Phone:919-333-3290
Mailing Address - Fax:
Practice Address - Street 1:6101 WALDERBROOK RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-3415
Practice Address - Country:US
Practice Address - Phone:919-333-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA516812372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion