MEDICARE: HEIDI BRESEE CRNP

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	R098403	MD

General Provider Information

NPI Number	:	1679983043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI BRESEE CRNP

Provider Business Mailing Address
First Line	:	9813 MOUNT TABOR RD
Second Line	:
City	:	MYERSVILLE
State	:	MD
Zip	:	21773-8003
Country	:	US
Telephone Number	:	240-372-5053
Fax Number	:

Provider Business Practice Location Address
First Line	:	9813 MOUNT TABOR RD
Second Line	:
City	:	MYERSVILLE
State	:	MD
Zip	:	21773-8003
Country	:	US
Telephone Number	:	240-372-5053
Fax Number	:

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

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	05/06/2014

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