Mark Brent, LVN

Individual provider Active NPI Licensed Vocational Nurse · Bastrop, TX

NPI 1487986378 · NPPES record last updated Feb 3, 2010

Key facts

NPI
1487986378
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Vocational Nurse 164X00000X
License
104432 (TX)
Practice address
181 S Buckhorn Dr
Bastrop, TX 78602-5602
Phone
(515) 321-3755
NPI assigned
Feb 3, 2010
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
104432TXMDLicensed Vocational Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational Nurse 164X00000X 104432 TX Yes

Addresses

Primary practice location

181 S Buckhorn Dr
Bastrop, TX 78602-5602

Mailing address

181 S Buckhorn Dr
Bastrop, TX 78602-5602
Phone (515) 321-3755

Other providers in Bastrop, TX

All providers in Bastrop, TX · Licensed Vocational Nurse in Texas

Sources for this page

Verify at the official NPI Registry.