MEDICARE: MRS. STEPHENIE VANDERMEER BRINSON FNP-BC

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	363LF0000X	Family Nurse Practitioner	201699	NC
2	207Q00000X	Family Medicine Physician	201699	NC

General Provider Information

NPI Number	:	1578616132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHENIE VANDERMEER BRINSON FNP-BC

Provider Business Mailing Address
First Line	:	876 TIMBER DR
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-4850
Country	:	US
Telephone Number	:	919-803-2285
Fax Number	:	919-803-2318

Provider Business Practice Location Address
First Line	:	876 TIMBER DR
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-4850
Country	:	US
Telephone Number	:	919-803-2285
Fax Number	:	919-803-2318

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/29/2014

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