Healthcare Provider Details

I. General information

NPI: 1184933004
Provider Name (Legal Business Name): BRENDA DENNIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 8TH ST STE 102
GLEN DALE WV
26038-1451
US

IV. Provider business mailing address

426 8TH ST STE 102
GLEN DALE WV
26038-1451
US

V. Phone/Fax

Practice location:
  • Phone: 304-845-8444
  • Fax: 304-845-8446
Mailing address:
  • Phone: 304-845-8444
  • Fax: 304-845-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number48351
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN48351
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: