Provider Demographics
NPI:1285193086
Name:MCBRIDE, TRENDALEN
Entity Type:Individual
Prefix:
First Name:TRENDALEN
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 DYSON ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5722
Mailing Address - Country:US
Mailing Address - Phone:231-719-5881
Mailing Address - Fax:231-766-7590
Practice Address - Street 1:1638 DYSON ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5722
Practice Address - Country:US
Practice Address - Phone:231-719-5881
Practice Address - Fax:231-766-7590
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM216802488770343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0OtherNON EMERGENCY TRANSPORTATION