MEDICARE: BRENDA WHITEHEAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0200X	Oncology Registered Nurse	14225996-3102	UT

General Provider Information

NPI Number	:	1144157306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA WHITEHEAD

Provider Business Mailing Address
First Line	:	8624 E 100 S
Second Line	:
City	:	HUNTSVILLE
State	:	UT
Zip	:	84317-9633
Country	:	US
Telephone Number	:	801-558-0966
Fax Number	:

Provider Business Practice Location Address
First Line	:	8624 E 100 S
Second Line	:
City	:	HUNTSVILLE
State	:	UT
Zip	:	84317-9633
Country	:	US
Telephone Number	:	801-558-0966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ BRENDA WHITEHEAD ” Practice Location

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