Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 37408 | WV |
NPI | 1073983813 |
---|---|
Provider Name | Brenda Hashem |
First Address | Berkeley Springs, WV 25411-7463 |
Second Address | Berkeley Springs, WV 25411-7463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2015 |
Last Update Date | 15/03/2021 |