Healthcare Provider Details

I. General information

NPI: 1184461055
Provider Name (Legal Business Name): BRENDA RENEE MAJORS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRENDA RENEE WOODS

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 E WASHINGTON BLVD
FORT WAYNE IN
46803-1536
US

IV. Provider business mailing address

3010 STARDALE DR
FORT WAYNE IN
46816-1436
US

V. Phone/Fax

Practice location:
  • Phone: 260-310-9599
  • Fax:
Mailing address:
  • Phone: 260-435-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: