MEDICARE: VERNENDIA ANNE CRUEL N.P.

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	363L00000X	Nurse Practitioner	RN145300NP	GA

General Provider Information

NPI Number	:	1760476949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNENDIA ANNE CRUEL N.P.

Provider Business Mailing Address
First Line	:	550 PEACHTREE NEST 1600
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2246
Country	:	US
Telephone Number	:	404-881-1094
Fax Number	:	404-874-1249

Provider Business Practice Location Address
First Line	:	1800 HOWELL MILL RD NW
Second Line	:	SUITE 600
City	:	ATLANTA
State	:	GA
Zip	:	30318-2538
Country	:	US
Telephone Number	:	404-351-9512
Fax Number	:

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	09/24/2015

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