MEDICARE: YOLANDA FAYE BROTHERS

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	164W00000X	Licensed Practical Nurse	68283	NC

General Provider Information

NPI Number	:	1598075962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA FAYE BROTHERS

Provider Business Mailing Address
First Line	:	4107 TRIANA COURT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-6483
Country	:	US
Telephone Number	:	252-267-2163
Fax Number	:

Provider Business Practice Location Address
First Line	:	4107 TRIANA COURT
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-6483
Country	:	US
Telephone Number	:	252-267-2163
Fax Number	:

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

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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Directions to “ YOLANDA FAYE BROTHERS ” Practice Location

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