Provider Demographics
NPI:1609692359
Name:ALLEN, BRENDA YVETTE
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:YVETTE
Last Name:ALLEN
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 1:953 BEACONSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1796
Mailing Address - Country:US
Mailing Address - Phone:313-264-8064
Mailing Address - Fax:
Practice Address - Street 1:953 BEACONSFIELD AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1796
Practice Address - Country:US
Practice Address - Phone:313-264-8064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver