Provider Demographics
NPI:1821115502
Name:MCDONALD, BRENDA SUE (CST CFA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CST CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1736
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80034-1736
Mailing Address - Country:US
Mailing Address - Phone:303-942-0088
Mailing Address - Fax:
Practice Address - Street 1:4045 FIELD DR
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4357
Practice Address - Country:US
Practice Address - Phone:303-942-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist