MEDICARE: HEIDI MCBROOM 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	163W00000X	Registered Nurse	937470	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	937470	OTHER	TX	TEXAS BOARD OF NURSING

General Provider Information

NPI Number	:	1295212934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI MCBROOM RN

Provider Business Mailing Address
First Line	:	31 MILL CREEK DR
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-2509
Country	:	US
Telephone Number	:	713-294-4221
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 MILL CREEK DR
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-2509
Country	:	US
Telephone Number	:	713-294-4221
Fax Number	:

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

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	07/25/2018

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Directions to “ HEIDI MCBROOM RN” Practice Location

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