MEDICARE: MS. BRENDA WOOD BERDICK FNP-C

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	0024164888	VA

General Provider Information

NPI Number	:	1962511618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA WOOD BERDICK FNP-C

Provider Business Mailing Address
First Line	:	6024 16TH ST N
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22205-2208
Country	:	US
Telephone Number	:	703-532-2534
Fax Number	:

Provider Business Practice Location Address
First Line	:	8350 RICHMOND HWY
Second Line	:	SUITE 301
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-2300
Country	:	US
Telephone Number	:	703-704-5333
Fax Number	:	703-704-6679

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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