MEDICARE: VICKI BRADY APRN

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	153338	MO

General Provider Information

NPI Number	:	1801872080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI BRADY APRN

Provider Business Mailing Address
First Line	:	3500 TOWER AVE
Second Line	:
City	:	SUPERIOR
State	:	WI
Zip	:	54880-5335
Country	:	US
Telephone Number	:	715-395-5454
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 TOWER AVE
Second Line	:
City	:	SUPERIOR
State	:	WI
Zip	:	54880-5335
Country	:	US
Telephone Number	:	715-395-5454
Fax Number	:

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	08/06/2007

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Directions to “ VICKI BRADY APRN” Practice Location

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