MEDICARE: LAURIE ANN BREBRICK MSN

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	112396	WI
2	363L00000X	Nurse Practitioner	953	WI

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	:	1750386330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE ANN BREBRICK MSN

Provider Business Mailing Address
First Line	:	3220 MISSION AVE STE 1
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-1354
Country	:	US
Telephone Number	:	760-433-3155
Fax Number	:	760-722-7359

Provider Business Practice Location Address
First Line	:	3220 MISSION AVE STE 1
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-1354
Country	:	US
Telephone Number	:	760-433-3155
Fax Number	:	760-722-7359

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/01/2010

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