MEDICARE: MRS. CHARLENE BROSIUS REGISTERED NURSE

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	163WH0200X	Home Health Registered Nurse	297962-01	NY

General Provider Information

NPI Number	:	1194469791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLENE BROSIUS REGISTERED NURSE

Provider Business Mailing Address
First Line	:	7183 SCHULTZ RD
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-9646
Country	:	US
Telephone Number	:	716-512-8474
Fax Number	:

Provider Business Practice Location Address
First Line	:	7183 SCHULTZ RD
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-9646
Country	:	US
Telephone Number	:	716-512-8474
Fax Number	:

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

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	04/21/2022

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