MEDICARE: BONNIE L. BRENEMAN RNC/WHNP

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	363LW0102X	Women's Health Nurse Practitioner	0024050799	VA

General Provider Information

NPI Number	:	1134127145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE L. BRENEMAN RNC/WHNP

Provider Business Mailing Address
First Line	:	7689 SHEFFIELD VILLAGE LN
Second Line	:
City	:	LORTON
State	:	VA
Zip	:	22079-1718
Country	:	US
Telephone Number	:	703-550-6023
Fax Number	:	703-805-0311

Provider Business Practice Location Address
First Line	:	9501 FARRELL RD
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-5901
Country	:	US
Telephone Number	:	703-805-0311
Fax Number	:	703-805-9351

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/08/2007

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