MEDICARE: QIANA BROST

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	624287-1	NY

General Provider Information

NPI Number	:	1548691041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QIANA BROST

Provider Business Mailing Address
First Line	:	67 COURTNEY LOOP
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3152
Country	:	US
Telephone Number	:	718-552-0185
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 COURTNEY LOOP
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3152
Country	:	US
Telephone Number	:	718-552-0185
Fax Number	:

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

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	12/09/2013

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Directions to “ QIANA BROST ” Practice Location

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