Provider Demographics
NPI:1780934620
Name:GENDRON, BRENDA MARIE
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MARIE
Last Name:GENDRON
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 1:21 KIMBERLY LN
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2631
Mailing Address - Country:US
Mailing Address - Phone:413-527-4276
Mailing Address - Fax:
Practice Address - Street 1:21 KIMBERLY LANE
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-2631
Practice Address - Country:US
Practice Address - Phone:413-527-4276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN52300164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse