MEDICARE: MRS. PATTIE S. BRANDON 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	29959	WI

General Provider Information

NPI Number	:	1225262058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATTIE S. BRANDON LPN

Provider Business Mailing Address
First Line	:	PO BOX 240471
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3162
Country	:	US
Telephone Number	:	414-699-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	7938 NORTH 107TH STREET
Second Line	:	APT 3
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-3162
Country	:	US
Telephone Number	:	414-699-3937
Fax Number	:

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

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	05/07/2009

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