Basic Information
| Provider Information | |||||||||
| NPI: | 1518494038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCLENDON | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3290 | ||||||||
| Address2: | |||||||||
| City: | LA GRANDE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978507290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419638421 | ||||||||
| FaxNumber: | 5419631476 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 SUNSET DR STE F | ||||||||
| Address2: | |||||||||
| City: | LA GRANDE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978501200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416633100 | ||||||||
| FaxNumber: | 5419755135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2017 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | TL0006573 | CO | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | DO210510 | OR | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.