MEDICARE: TAQIYAH KAREEMAH BRUMFIELD RN

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	163W00000X	Registered Nurse	950312	TX

General Provider Information

NPI Number	:	1871071480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAQIYAH KAREEMAH BRUMFIELD RN

Provider Business Mailing Address
First Line	:	2609 ARLINGTON LN
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75134-2437
Country	:	US
Telephone Number	:	469-404-5741
Fax Number	:

Provider Business Practice Location Address
First Line	:	2609 ARLINGTON LN
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75134-2437
Country	:	US
Telephone Number	:	469-404-5741
Fax Number	:

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

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	08/06/2018

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