Healthcare Provider Details

I. General information

NPI: 1003455403
Provider Name (Legal Business Name): BRENNA LANSDEN MSN,FNP-C,IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 CHEAT RD
MORGANTOWN WV
26508-4210
US

IV. Provider business mailing address

608 CHEAT RD
MORGANTOWN WV
26508-4210
US

V. Phone/Fax

Practice location:
  • Phone: 304-594-1313
  • Fax:
Mailing address:
  • Phone: 304-594-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-160867
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number117113
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: