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NPI Code Detail

MEDICARE: BRENT ROBERT BRASWELL FNP

MEDICARE: BRENT ROBERT BRASWELL FNP
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
1363LF0000XFamily Nurse Practitioner1010134613VT

General Provider Information

NPI Number : 1316556921
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT ROBERT BRASWELL FNP
Provider Business Mailing Address
First Line : PO BOX 905
Second Line :
City : ST JOHNSBURY
State : VT
Zip : 05819-0905
Country : US
Telephone Number : 802-748-8141
Fax Number : 802-748-4098
Provider Business Practice Location Address
First Line : 195 INDUSTRIAL PKWY STE 1
Second Line :
City : LYNDONVILLE
State : VT
Zip : 05851-4511
Country : US
Telephone Number : 802-748-9501
Fax Number : 802-748-3420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2020
Last Update Date : 07/29/2020

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Directions to “ BRENT ROBERT BRASWELL FNP” Practice Location

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