MEDICARE: ANNETTE RACHEL BROSS FNP-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	363LF0000X	Family Nurse Practitioner	685649	TX

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	:	1790999712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE RACHEL BROSS FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 911230
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75391-1230
Country	:	US
Telephone Number	:	972-997-8000
Fax Number	:	972-437-9605

Provider Business Practice Location Address
First Line	:	7515 MAIN ST STE 740
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4517
Country	:	US
Telephone Number	:	713-795-0202
Fax Number	:	713-795-0363

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	02/12/2009

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