MEDICARE: DENA BRELSFORD PA

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	363A00000X	Physician Assistant	PA01475	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA01475	OTHER	TX	PHYSICIAN ASSISTANTS

General Provider Information

NPI Number	:	1740294156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENA BRELSFORD PA

Provider Business Mailing Address
First Line	:	444 SW CENTER ST
Second Line	:	PO BOX 187
City	:	FASION
State	:	NC
Zip	:	28341-2834
Country	:	US
Telephone Number	:	910-267-0421
Fax Number	:	910-267-8989

Provider Business Practice Location Address
First Line	:	1401 W JEFFERSON BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-5326
Country	:	US
Telephone Number	:	214-941-9200
Fax Number	:

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	04/03/2017

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Directions to “ DENA BRELSFORD PA” Practice Location

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