MEDICARE: NANCY BROHAWN RDH,BSDH

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	124Q00000X	Dental Hygienist	G2-0000865	DE

General Provider Information

NPI Number	:	1578915534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY BROHAWN RDH,BSDH

Provider Business Mailing Address
First Line	:	39 COUNTRY HILLS DR
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19711-2517
Country	:	US
Telephone Number	:	302-453-1866
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 COUNTRY HILLS DR
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19711-2517
Country	:	US
Telephone Number	:	302-453-1866
Fax Number	:

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

Provider Enumeration Date	:	07/01/2016
Last Update Date	:	07/01/2016

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