MEDICARE: MARIA ISABEL BRICKNER ARNP, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G172452	IA

General Provider Information

NPI Number	:	1790499648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA ISABEL BRICKNER ARNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	3421 CHEYENNE RANCH RD
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-4547
Country	:	US
Telephone Number	:	682-390-9956
Fax Number	:

Provider Business Practice Location Address
First Line	:	3421 CHEYENNE RANCH RD
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-4547
Country	:	US
Telephone Number	:	682-390-9956
Fax Number	:

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

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	01/05/2023

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