MEDICARE: MRS. BRENDA J SHRADER 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	163WA2000X	Administrator Registered Nurse	RN0000033753	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669549846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA J SHRADER RN

Provider Business Mailing Address
First Line	:	901 NANCE RD
Second Line	:
City	:	NEW MARKET
State	:	TN
Zip	:	37820-3551
Country	:	US
Telephone Number	:	865-475-1841
Fax Number	:	865-475-1841

Provider Business Practice Location Address
First Line	:	901 NANCE RD
Second Line	:
City	:	NEW MARKET
State	:	TN
Zip	:	37820-3551
Country	:	US
Telephone Number	:	865-475-1841
Fax Number	:	865-475-1841

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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