Basic Information
| Provider Information | |||||||||
| NPI: | 1306251863 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEW | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1219 E HARBOR VIEW DR | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852832117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102808799 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4838 E. BASELINE ROAD | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809812400 | ||||||||
| FaxNumber: | 4809812407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2014 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | CRNA1050 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.