Provider Demographics
NPI:1326703000
Name:THOMAS, BRENDA E (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:E
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3079 S BALDWIN RD STE 1012
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1028
Mailing Address - Country:US
Mailing Address - Phone:248-464-6540
Mailing Address - Fax:248-393-2822
Practice Address - Street 1:731 E BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2914
Practice Address - Country:US
Practice Address - Phone:248-464-6540
Practice Address - Fax:248-393-2822
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service