Provider Demographics
NPI:1386629624
Name:MCCALL, BRENDA WREN (CRNA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:WREN
Last Name:MCCALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:WREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:1500 CITYWEST BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2300
Practice Address - Country:US
Practice Address - Phone:713-620-4000
Practice Address - Fax:713-458-4229
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP108277367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00001009OtherRAILROAD MEDICARE
TX150666904Medicaid
TX150666907Medicaid
TX85286UOtherBLUE CROSS/BLUE SHIELD
TX82855UOtherBLUE CROSS/BLUE SHIELD
TX8F0068Medicare ID - Type Unspecified
TX150666904Medicaid
S26363Medicare UPIN