Provider Demographics
NPI:1356991590
Name:MCGOWN, BRENDA DIANE
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:DIANE
Last Name:MCGOWN
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 1:7405 WALLING LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7337
Mailing Address - Country:US
Mailing Address - Phone:512-574-5352
Mailing Address - Fax:
Practice Address - Street 1:7405 WALLING LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7337
Practice Address - Country:US
Practice Address - Phone:512-574-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider