MEDICARE: BRYNN M MERENESS RN

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	729964	TX

General Provider Information

NPI Number	:	1679870414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYNN M MERENESS RN

Provider Business Mailing Address
First Line	:	PO BOX 435
Second Line	:
City	:	STILWELL
State	:	KS
Zip	:	66085-0435
Country	:	US
Telephone Number	:	713-344-2400
Fax Number	:	713-344-9420

Provider Business Practice Location Address
First Line	:	4400 S WASHINGTON ST
Second Line	:	STE 107
City	:	AMARILLO
State	:	TX
Zip	:	79110-2052
Country	:	US
Telephone Number	:	713-344-2400
Fax Number	:	713-344-9420

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

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	02/14/2011

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