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MRS. BRENDA MARIE BLACK LPN
>> Licensed Practical Nurse >> Nursing Service ProvidersRegistrant NPI Number: 1518122563
Individual Registrant:MRS. BRENDA MARIE BLACK LPN
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
150 MEMORIAL DRIVE 150 MEMORIAL DRIVE REIDSVILLE, GA 30453 US
Tel: 912-557-6794 Fax: 912-557-6817
Tel: 912-557-6794 Fax: 912-557-6817
Contact information for business:
PO BOX 818 150 MEMORIAL DRIVE REIDSVILLE, GA 30453-0818 US
Tel: 912-557-6794 Fax: 912-557-6817
Tel: 912-557-6794 Fax: 912-557-6817
Registration Information:
NPI: 1518122563
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 164W00000X | Nursing Service Providers Licensed Practical Nurse | GA | LPN051788 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
