MEDICARE: MARIA BROOK VASQUEZ RIVERA 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	163W00000X	Registered Nurse	178708-30	WI

General Provider Information

NPI Number	:	1740527423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA BROOK VASQUEZ RIVERA RN

Provider Business Mailing Address
First Line	:	614 ORCHARD ST
Second Line	:
City	:	WAUSAU
State	:	WI
Zip	:	54403-3001
Country	:	US
Telephone Number	:	715-551-9340
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 ORCHARD ST
Second Line	:
City	:	WAUSAU
State	:	WI
Zip	:	54403-3001
Country	:	US
Telephone Number	:	715-551-9340
Fax Number	:

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

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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