MEDICARE: ELEANOR BREMER

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	0024170168	VA

General Provider Information

NPI Number	:	1841555851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR BREMER

Provider Business Mailing Address
First Line	:	6037 CORWIN DR
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-7066
Country	:	US
Telephone Number	:	804-355-3335
Fax Number	:	804-355-3335

Provider Business Practice Location Address
First Line	:	4881 COX RD
Second Line	:	BLDG. 1
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-6293
Country	:	US
Telephone Number	:	804-968-3418
Fax Number	:

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

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	04/13/2016

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