Provider Demographics
NPI:1679321319
Name:PICKETT, BRENICE DANYELL
Entity type:Individual
Prefix:
First Name:BRENICE
Middle Name:DANYELL
Last Name:PICKETT
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 1:5919 BURGUNDY ST
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-2004
Mailing Address - Country:US
Mailing Address - Phone:202-597-8673
Mailing Address - Fax:
Practice Address - Street 1:1420 DOWNING ST NE APT 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3428
Practice Address - Country:US
Practice Address - Phone:202-597-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant