Basic Information
| Provider Information | |||||||||
| NPI: | 1912567363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS-WHITEHEAD | ||||||||
| FirstName: | BRENDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 S WILLOW ST STE 128 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031035705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009952673 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9109 LIBERTY RD | ||||||||
| Address2: | |||||||||
| City: | RANDALLSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211333521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106557373 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2019 | ||||||||
| LastUpdateDate: | 06/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0001177421 | VA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.