MEDICARE: MS. RAVEN BETH BRUST R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28071997A	IN

General Provider Information

NPI Number	:	1205083953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RAVEN BETH BRUST R.N.

Provider Business Mailing Address
First Line	:	2800 KISSEL RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-7150
Country	:	US
Telephone Number	:	812-483-8734
Fax Number	:	812-963-1191

Provider Business Practice Location Address
First Line	:	2800 KISSEL RD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47720-7150
Country	:	US
Telephone Number	:	812-483-8734
Fax Number	:	812-963-1191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	08/25/2008

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