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General NPI Number Information
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NPI Number | 1982746673
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Entity Type | Organization
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Legal Business Name | BRENHAM FAMILY CARE, PLLC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 605 MEDICAL CT STE 201
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City | BRENHAM
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State | TX
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Zip | 77833-5406
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Country | US
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Telephone | 979-830-1441
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Fax | 979-830-1369
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Provider Business Mailing Address
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Address Line | 605 MEDICAL CT STE 201
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City | BRENHAM
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State | TX
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Zip | 77833-5406
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Country | US
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Telephone | 979-830-1441
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Fax | 979-830-1369
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Authorized Official
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Title or Position | OFFICE ADMINISTRATION
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Name | MRS. EDNA M BUSTOS
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Credential |
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Telephone | 979-830-1441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 525996
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License Number State | TX
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