MEDICARE: BRENDA MCALLISTER RN

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	163WC1500X	Community Health Registered Nurse		OR

General Provider Information

NPI Number	:	1184742454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA MCALLISTER RN

Provider Business Mailing Address
First Line	:	PO BOX 494
Second Line	:
City	:	WALDPORT
State	:	OR
Zip	:	97394-0494
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4422 NE DEVILS LAKE BLVD STE 2
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-5000
Country	:	US
Telephone Number	:	541-994-0227
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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