Healthcare Provider Details

I. General information

NPI: 1861482168
Provider Name (Legal Business Name): BRENDA JEAN HOUSTON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FERRELL RD
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

5980 SITGREAVES RD
FORT BELVOIR VA
22060-3219
US

V. Phone/Fax

Practice location:
  • Phone: 703-805-0950
  • Fax:
Mailing address:
  • Phone: 703-781-5945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: