MEDICARE: MRS. BRENDA JEAN ASWAD LPN

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	164W00000X	Licensed Practical Nurse	156852	NY

General Provider Information

NPI Number	:	1033523295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA JEAN ASWAD LPN

Provider Business Mailing Address
First Line	:	7413 EADES RD
Second Line	:
City	:	RED CREEK
State	:	NY
Zip	:	13143-3151
Country	:	US
Telephone Number	:	315-754-8707
Fax Number	:	315-754-8707

Provider Business Practice Location Address
First Line	:	7413 EADES RD
Second Line	:
City	:	RED CREEK
State	:	NY
Zip	:	13143-3151
Country	:	US
Telephone Number	:	315-754-8707
Fax Number	:	315-754-8707

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

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/16/2014

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