Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | IL |
NPI | 1093709800 |
---|---|
Provider Name | Darlene Ruth Brunner |
First Address | Scott Afb, IL 62225-5250 |
Second Address | Scott Afb, IL 62225-5250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 10/07/2007 |