MEDICARE: MRS. NANCY IRENE MUNN APRN

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	363LP0200X	Pediatric Nurse Practitioner	000476	CT

General Provider Information

NPI Number	:	1629053889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY IRENE MUNN APRN

Provider Business Mailing Address
First Line	:	17 FARVIEW RD
Second Line	:
City	:	BROOKFIELD
State	:	CT
Zip	:	06804-1805
Country	:	US
Telephone Number	:	203-775-3805
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 PARK AVE
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06604-4610
Country	:	US
Telephone Number	:	203-576-8168
Fax Number	:	203-576-8435

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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