Provider Demographics
NPI:1396022018
Name:MCDADE, BRENDA ANN
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:MCDADE
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 1:265 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-1946
Mailing Address - Country:US
Mailing Address - Phone:219-938-0308
Mailing Address - Fax:
Practice Address - Street 1:265 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-1946
Practice Address - Country:US
Practice Address - Phone:219-938-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1328WAOtherPERSONAL ID