MEDICARE: BRENDA RASCZEWSKI

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	163WC1500X	Community Health Registered Nurse	200641571RN	OR

General Provider Information

NPI Number	:	1477184695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA RASCZEWSKI

Provider Business Mailing Address
First Line	:	3235 6TH ST
Second Line	:
City	:	COLUMBIA CITY
State	:	OR
Zip	:	97018-9703
Country	:	US
Telephone Number	:	971-219-7722
Fax Number	:

Provider Business Practice Location Address
First Line	:	3235 6TH ST
Second Line	:
City	:	COLUMBIA CITY
State	:	OR
Zip	:	97018-9703
Country	:	US
Telephone Number	:	971-219-7722
Fax Number	:

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	01/27/2020

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