Healthcare Provider Details

I. General information

NPI: 1023103975
Provider Name (Legal Business Name): BRENDA S MCCLURE B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 GREGORY ST
SCOTTSBORO AL
35768-4239
US

IV. Provider business mailing address

508 GREGORY ST
SCOTTSBORO AL
35768-4239
US

V. Phone/Fax

Practice location:
  • Phone: 256-259-1774
  • Fax: 256-259-0761
Mailing address:
  • Phone: 256-259-1774
  • Fax: 256-259-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: