Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 006605 | AZ |
N | 111NI0900X | Internist | 006605 | AZ |
N | 207R00000X | Internist | 5101019387 | MI |
N | 111NI0900X | Internist | 5101019387 | MI |
Y | 207RH0002X | Hospice and Palliative Medicine | 207QH0002X | AZ |
NPI | 1033404553 |
---|---|
Provider Name | Dr. Bianca Stephanie Brunelli |
First Address | Phoenix, AZ 85006 |
Second Address | Phoenix, AZ 85006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2011 |
Last Update Date | 22/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041428 | (05) | AZ |
5315050625 | BOARD OF PHARMACY CONTROLLED SUBSTANCE LICENSE (01) | MI |