Individual
BRENDA ANN MCDADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
265 N HAMILTON ST, GARY, IN 46403-1946
(219) 938-0308
Mailing address
265 N HAMILTON ST, GARY, IN 46403-1946
(219) 938-0308
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1328WA
PERSONAL ID
IN
Enumeration date
11/09/2011
Last updated
11/09/2011
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