MEDICARE: VALERIE BRUST RN, BSN

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	RN.1624870	CO
2	163W00000X	Registered Nurse	RN.2299942	MA

General Provider Information

NPI Number	:	1588021521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE BRUST RN, BSN

Provider Business Mailing Address
First Line	:	PO BOX 535
Second Line	:
City	:	CRESTED BUTTE
State	:	CO
Zip	:	81224-0535
Country	:	US
Telephone Number	:	970-390-9080
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 ELK AVE
Second Line	:
City	:	CRESTED BUTTE
State	:	CO
Zip	:	81224-9998
Country	:	US
Telephone Number	:	970-390-9080
Fax Number	:

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

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	01/21/2016

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