Provider Demographics
NPI:1023873056
Name:HUFFMAN-ROWE, BRENDETTA
Entity type:Individual
Prefix:
First Name:BRENDETTA
Middle Name:
Last Name:HUFFMAN-ROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LARKSPUR CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2502
Mailing Address - Country:US
Mailing Address - Phone:919-338-6423
Mailing Address - Fax:
Practice Address - Street 1:10211 ALM ST STE 210
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8221
Practice Address - Country:US
Practice Address - Phone:919-620-5333
Practice Address - Fax:919-307-0323
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019659363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics