Doctor Name: | BRENDA JEAN JUSTICE |
NPI Number: | 1154516722 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PAC |
License Number: | |
Business Practice Address: | 125 E Main St Benson, NC - 275041506 |
Business Phone Number: | 9198943321 |
Business Fax Number: | 9198948742 |
Mailing Address: | 125 E Main St, BENSON |
State: | NC |
Postal Code: | 275041506 |
Phone Number: | 9198943321 |
Fax Number: | 9198948742 |
NPI Enumeration Date: | 09/07/2007 |
NPI Last Update Date: | 09/07/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |