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NPI Code Detail

MEDICARE: BRENNA EARNEST

MEDICARE:   BRENNA  EARNEST
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
1163WD0400XDiabetes Educator Registered Nurse50860WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121410126OTHERWVDIABETIC EDUCATOR

General Provider Information

NPI Number : 1982005955
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENNA EARNEST
Provider Business Mailing Address
First Line : 100 PIN OAK LN
Second Line :
City : KEYSER
State : WV
Zip : 26726-5908
Country : US
Telephone Number : 304-597-3774
Fax Number : 304-597-3536
Provider Business Practice Location Address
First Line : 100 PIN OAK LN
Second Line :
City : KEYSER
State : WV
Zip : 26726-5908
Country : US
Telephone Number : 304-597-3774
Fax Number : 304-597-3536
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2014
Last Update Date : 09/10/2014

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Directions to “ BRENNA EARNEST ” Practice Location

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