MEDICARE: MRS. BRENDA L ABERCROMBIE FNP, CNM

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	163WG0000X	General Practice Registered Nurse	129233	MO
2	363LF0000X	Family Nurse Practitioner	129223	MO
3	367A00000X	Advanced Practice Midwife	129223	MO

General Provider Information

NPI Number	:	1295708634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA L ABERCROMBIE FNP, CNM

Provider Business Mailing Address
First Line	:	12329 S HIGHWAY 39
Second Line	:
City	:	STOCKTON
State	:	MO
Zip	:	65785-8580
Country	:	US
Telephone Number	:	417-276-4663
Fax Number	:	636-600-5260

Provider Business Practice Location Address
First Line	:	12329 S HIGHWAY 39
Second Line	:
City	:	STOCKTON
State	:	MO
Zip	:	65785-8580
Country	:	US
Telephone Number	:	417-276-4663
Fax Number	:	636-600-5260

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	05/08/2009

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