Provider Demographics
NPI:1992765259
Name:HALSTEAD, BRENDA (NP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:HALSTEAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 E MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7071
Mailing Address - Country:US
Mailing Address - Phone:804-643-3061
Mailing Address - Fax:804-643-3817
Practice Address - Street 1:2201 E MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7071
Practice Address - Country:US
Practice Address - Phone:804-643-3061
Practice Address - Fax:804-643-3817
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164577363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
C06999Medicare UPIN