Provider Demographics
NPI:1386076776
Name:GROGAN, BRENDA FAY (LICENSED MIDWIFE)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:FAY
Last Name:GROGAN
Suffix:
Gender:F
Credentials:LICENSED MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 WASHINGTON ST S
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8008
Mailing Address - Country:US
Mailing Address - Phone:208-731-3398
Mailing Address - Fax:208-735-8390
Practice Address - Street 1:1431 WASHINGTON ST S
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8008
Practice Address - Country:US
Practice Address - Phone:208-731-3398
Practice Address - Fax:208-735-8390
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMIDGM-28176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife