MEDICARE: MRS. CHARITIE ANNE BRONSON B.S.

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1699001792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARITIE ANNE BRONSON B.S.

Provider Business Mailing Address
First Line	:	5916 BIG HORN VIEW ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-6806
Country	:	US
Telephone Number	:	702-612-3716
Fax Number	:	702-834-3544

Provider Business Practice Location Address
First Line	:	5916 BIG HORN VIEW ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-6806
Country	:	US
Telephone Number	:	702-612-3716
Fax Number	:	702-834-3544

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

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	09/22/2010

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