MEDICARE: BRENDA G WARE NP

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	363LA2200X	Adult Health Nurse Practitioner	256867	TX

General Provider Information

NPI Number	:	1265474035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA G WARE NP

Provider Business Mailing Address
First Line	:	2316 CRESTMEADOW ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76207-1639
Country	:	US
Telephone Number	:	940-390-5395
Fax Number	:

Provider Business Practice Location Address
First Line	:	5001 LYNDON B JOHNSON FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-6120
Country	:	US
Telephone Number	:	972-866-1696
Fax Number	:	972-866-1611

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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