Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | MT210279 | PA |
NPI | 1033555115 |
---|---|
Provider Name | Celina Veronica Brunson |
First Address | Brooklyn, NY 11226-4206 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2013 |
Last Update Date | 30/06/2016 |