MEDICARE: MRS. NATALIE BROOKE WIER RDMS, RVT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
2	2471S1302X	Sonography Radiologic Technologist
3	2471V0105X	Vascular Sonography Radiologic Technologist	MO

General Provider Information

NPI Number	:	1790342459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE BROOKE WIER RDMS, RVT

Provider Business Mailing Address
First Line	:	5704 SHACKELFORD CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-4521
Country	:	US
Telephone Number	:	573-882-6016
Fax Number	:

Provider Business Practice Location Address
First Line	:	5704 SHACKELFORD CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-4521
Country	:	US
Telephone Number	:	573-882-6016
Fax Number	:

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

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	05/28/2019

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