MEDICARE: MR. MATTHEW BRAEDEN TRUTSCHEL 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	RN 9315620	FL

General Provider Information

NPI Number	:	1558667303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW BRAEDEN TRUTSCHEL RN

Provider Business Mailing Address
First Line	:	7635 VILLAGE GREEN DR
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-9258
Country	:	US
Telephone Number	:	321-972-5041
Fax Number	:

Provider Business Practice Location Address
First Line	:	7635 VILLAGE GREEN DR
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-9258
Country	:	US
Telephone Number	:	321-972-5041
Fax Number	:

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

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/26/2011

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