MEDICARE: MRS. BRENDA SUE HALLS A.R.N.P.

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	363L00000X	Nurse Practitioner	A083438	IA

General Provider Information

NPI Number	:	1336177468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA SUE HALLS A.R.N.P.

Provider Business Mailing Address
First Line	:	2000B S MAIN ST
Second Line	:
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-9572
Country	:	US
Telephone Number	:	641-472-4156
Fax Number	:	641-472-9436

Provider Business Practice Location Address
First Line	:	2000B S MAIN ST
Second Line	:
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-9572
Country	:	US
Telephone Number	:	641-472-4156
Fax Number	:	641-472-9436

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	04/14/2021

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