Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN053623 | LA |
NPI | 1013937994 |
---|---|
Provider Name | Barbara Lynn Bruner |
First Address | Shreveport, LA 71103-4228 |
Second Address | Shreveport, LA 71103-4228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 31/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1459186 | (05) | LA |
Q24788 | (02) | LA |