MEDICARE: EILEEN MUELLER BRAY ARNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	ARNP 9261719	FL

General Provider Information

NPI Number	:	1114108404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN MUELLER BRAY ARNP

Provider Business Mailing Address
First Line	:	PO BOX 648
Second Line	:
City	:	CHIPLEY
State	:	FL
Zip	:	32428-0648
Country	:	US
Telephone Number	:	850-638-6240
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 SOUTH BLVD
Second Line	:
City	:	CHIPLEY
State	:	FL
Zip	:	32428-1846
Country	:	US
Telephone Number	:	850-638-6240
Fax Number	:

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

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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