Provider Demographics
NPI:1396340634
Name:GARRETSON, BRENDA LOU
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOU
Last Name:GARRETSON
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 1:165 JOHNS HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NELLIS
Mailing Address - State:WV
Mailing Address - Zip Code:25142-9717
Mailing Address - Country:US
Mailing Address - Phone:304-836-5002
Mailing Address - Fax:
Practice Address - Street 1:73 EMMONS RD
Practice Address - Street 2:
Practice Address - City:ASHFORD
Practice Address - State:WV
Practice Address - Zip Code:25009-9572
Practice Address - Country:US
Practice Address - Phone:304-836-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant