Provider Demographics
NPI:1295758506
Name:GAINES, BRENDA
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:
Last Name:GAINES
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 1:4501 SALT MARSH CIR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6811
Mailing Address - Country:US
Mailing Address - Phone:843-357-6817
Mailing Address - Fax:
Practice Address - Street 1:5190 HWY 17 BYPASS
Practice Address - Street 2:SUITE C
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6811
Practice Address - Country:US
Practice Address - Phone:843-357-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171W00000XOther Service ProvidersContractor
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies