Provider Demographics
NPI:1003931064
Name:GRIDLEY, BRENDA MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MARIE
Last Name:GRIDLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:MARIE
Other - Last Name:BARBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:695 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5665
Practice Address - Country:US
Practice Address - Phone:480-821-2838
Practice Address - Fax:480-821-9444
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ918544133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered