Provider Demographics
NPI:1669549846
Name:SHRADER, BRENDA J (RN)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:J
Last Name:SHRADER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NANCE RD
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:TN
Mailing Address - Zip Code:37820-3551
Mailing Address - Country:US
Mailing Address - Phone:865-475-1841
Mailing Address - Fax:865-475-1841
Practice Address - Street 1:901 NANCE RD
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:TN
Practice Address - Zip Code:37820-3551
Practice Address - Country:US
Practice Address - Phone:865-475-1841
Practice Address - Fax:865-475-1841
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRN0000033753163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454624Medicaid
TN4440770001Medicare ID - Type Unspecified