MEDICARE: BRENDA LEE NOSS PA

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	363A00000X	Physician Assistant	OA000712	PA
2	363AM0700X	Medical Physician Assistant	MA003454L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	114212	OTHER	PA	MC PTAN

General Provider Information

NPI Number	:	1487680435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA LEE NOSS PA

Provider Business Mailing Address
First Line	:	5000 COX RD
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-9263
Country	:	US
Telephone Number	:	804-822-4355
Fax Number	:

Provider Business Practice Location Address
First Line	:	6451 VILLAGE LN
Second Line	:
City	:	MACUNGIE
State	:	PA
Zip	:	18062-8484
Country	:	US
Telephone Number	:	610-967-2772
Fax Number	:	610-967-2559

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	03/03/2022

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