MEDICARE: STELLA LEBRUN

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	9233253	FL

General Provider Information

NPI Number	:	1871983544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STELLA LEBRUN

Provider Business Mailing Address
First Line	:	204 KENSINGTON WAY
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33414-4316
Country	:	US
Telephone Number	:	561-633-2062
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 KENSINGTON WAY
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33414-4316
Country	:	US
Telephone Number	:	561-633-2062
Fax Number	:

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

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	02/02/2015

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