Individual
BRENDA WILSON MICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4917 DAFFODIL CIR, GLEN ALLEN, VA 23060-3558
(804) 839-3642
(804) 303-0810
Mailing address
4917 DAFFODIL CIR, GLEN ALLEN, VA 23060-3558
(804) 839-3642
(804) 303-0810
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
02/28/2020
Last updated
02/28/2020
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