MEDICARE: MRS. REGINA BRENTON NP

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	363LA2200X	Adult Health Nurse Practitioner	26NR09737500	NJ

General Provider Information

NPI Number	:	1952709214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REGINA BRENTON NP

Provider Business Mailing Address
First Line	:	1121 CRANBROOK RD
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-6328
Country	:	US
Telephone Number	:	646-318-6794
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 CRANBROOK RD
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-6328
Country	:	US
Telephone Number	:	646-318-6794
Fax Number	:

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

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	12/18/2014

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